冰毯术中、术后亚低温治疗重型创伤性脑损伤的疗效

Effect of intra-and post-operative mild hypothermia with ice blanket in treatment of severe traumatic brain injury

目的 观察冰毯术中、术后亚低温对重型创伤性脑损伤（severe traumatic brain injury,sTBI）的疗效. 方法 选择GCS 3～8分sTBI患者20例,按随机数字表法分为冰袋降温组（Bag组）和冰毯降温组（Blanket组）,每组10例.前者用冰袋置大血管处降温,后者用冰毯（设定鼻咽温33 ～34℃）降温,均维持术中和术后48 h.两组均于术前10 min（To）和术后8,12,24,48,72 h（T1、T2、T3、T4、T5）记录颅内压、脑灌注压（CPP）和GCS评分；T0、T3、T4、T5及术后96 h（T6）取静脉血以ELISA法测定血清神经元特异性烯醇化酶（neuron-specific enolase,NSE）、髓鞘碱性蛋白（myelin basic protein,MBP）和S-100β蛋白浓度.记录术后6个月格拉斯哥预后评分（GOS）.结果 Bag组T1～T5时体温较T0降低不显著（P＞0.05）,NSE（T3～T6）、S-100β（T3～T6）及MBP（T4～T6）升高（P ＜0.05或0.01）；颅内压T2～ T5时较T1升高,CPP T3 ～T5时降低（P＜0.05）.Blanket组体温T1～T5时较T0显著降低（P ＜0.001）; NSE（T3～T6）、MBP（T5 ～T6）及S-100β（T4～T6）升高（P ＜0.05或0.01）；颅内压T2～T6时较T1升高（P＜0.05）,CPP降低不显著（P＞0.05）.与Bag组比较,Blanket组体温（T1～T5）低,颅内压（T2～T5）低,CPP（T3～T5）高,NSE（T4 ～T6）、MBP（T4～T6）及S-100β（T6）低（P＜0.05或0.01）.两组GCS和GOS评分差异无统计学意义（P＞0.05）. 结论 冰毯术中、术后亚低温治疗可减轻sTBI患者的脑损伤程度.

Objective To observe effect of intra-and post-operative mild hypothermia using an ice blanket on patients with severe traumatic brain injury （sTBI）.Methods Twenty sTBI patients with Glasgow Coma Scale （GCS） of 3-8 points were included and were assigned to either ice bag cooling （Bag group） or ice blanket cooling （Blanket group） （n =10 each） according to random number table.Patients in Bag group had temperature reduction by placing ice bag over great vessels,whereas in Blanket group an ice blanket （temperature was set as the nasopharyngeal temperature of 33℃-34℃） was employed to have temperature reduction.Hypothermia therapy in the two group groups was initiated from the beginning of operation and continued for 48 hours after operation.Intracranial pressure,cerebral perfusion pressure （CPP） and GCS in both groups were recorded respectively at 10 minutes before operation （T0） and at 8,12,24,48 and 72 hours after operation （T1,T2,T3,T4 and T5）.Venous blood of the two groups was harvested to assay the serum concentration of neuronspecific enolase （NSE）,myelin basic protein （MBP）and S-100β at T0,T3,T4,-Ts and at 96 hours after operation （T6） by ELISA method.Glasgow Outcome Scale （GOS） was evaluated at postoperative six months.Results In Bag group,body temperature （T1-T5） of the patients had no significant decrease （P 〉 0.05） and NSE （T3-T6）,S-100β （T3-T6） and MBP （T4-T6） were increased （P 〈 0.05 or 0.01） when compared with those in T0 ; intracranial pressure （T2-T5） was increased （P 〈 0.05） and CPP （T3-T5） was lowered （P 〈 0.05） when compared with those in T1.In Blanket group,body temperature （T1-T6） of the patients presented was decreased significantly （P 〈 0.01） and NSE （T3-T6）,MBP （T5-T6） and S-100β （T4-T6） were increased （P 〈 0.05 or 0.01） when compared those in T0 ; intracranial pressure （T2-T6） was increased （P 〈 0.05） and CPP had no significant changes （P 〉0.05） when compared with those in T1.By contrast with those in the same time points in Bag group,lower body temperature （T1-T5） （P 〈 0.001）,lower intracranial pressure （T2-T5）,higher CPP （T3-T5） as well as lower NSE （T4-T6）,MBP （T4-T6） and S-100β（T6）were observed in Blanket group （P 〈0.05 or 0.01）.Changes of GCS and GOS in the two groups were no significance （P 〉0.05）.Conclusion Intraoperative and postoperative mild hypothermia therapy using an ice blanket may alleviate the degree of brain injury in sTBI patients.