全身及局部亚低温治疗对脑出血所致脑水肿的影响

Effect of whole-body hypothermia therapy and local mild hypothermia on cerebral edema after intracerebral hemorrhage

目的探讨亚低温治疗对大面积幕上自发性脑出血(ICH)患者(出血量>25mL)出血灶周围水肿的影响,同时观察全身亚低温及头部局部亚低温在限制脑水肿、改善神经功能缺损等方面的作用。方法共41例ICH患者接受了亚低温治疗,全身亚低温组22例,头部局部亚低温组19例。在入院后第1,2,3,6,11,14天对所有患者进行CT检查,计算血肿及脑水肿体积。入院时进行GCS评分,发病后90 d进行mRS评分以评估预后。比较全身亚低温组及头部局部亚低温组上述参数的差异。结果全身亚低温组低温诱导时间明显短于头部局部亚低温组。全身亚低温组脑水肿体积无明显变化,头部局部亚低温组脑水肿体积有明显增大,2组间比较有显著性差异。结论亚低温治疗是治疗ICH安全有效的方法,其中全身亚低温治疗在限制ICH后出血灶周围水肿的形成方面效果比头部局部亚低温好。

Objective It is to explore the effect of hypothermia on edema surrounding hemorrhage in the patients with larespontaneous intracerebral hemorrhage （ICH） （blood quality 〉 25 mL）, and to observe the effect of whole-body hypothermiatherapy and local mild hypothermia therapy in inhibiting cerebral edema and improving neurologic impairment. Methods Fortyone patients with ICH were treated by hypothermia therapy including whole-body hypothermia group （22 patients） and selectivehead hypothermia group （19 patients）. Evolution of hematoma volume and perifocal edema were evaluated with CT at 1,2,3,6,11, 14 days after hospital admission. GCS was assessed on hospital admission, and mRS was assessed in 90 days after func-tional outcome to evaluate the prognosis. The differences in the indexes above between the two groups were compared. ResultsLow temperature induction time of whole-body hypothermia group was significantly shorter than that of selective head hypothermiagroup. No obvious change of cerebral edema volume was found in whole-body hypothermia group, but the volume increased obvi-ously in selective head hypothermia group, compared with each other, the difference was significant. Conclusion Whole bodyhypothermia therapy is a effective and safe method for treating ICH, and the effect of whole-body hypothermia therapy on preven-tion for the increase of peri-hemorrhagic edema after ICH is better than that of selective head hypothermia therapy.