快速输入4℃生理盐水诱导亚低温治疗重型颅脑损伤的初步研究

Preliminary investigation of rapid infusion of 4 ℃ saline for induction of mild hypothermia in treating severe traumatic brain injury

目的应用4℃生理盐水(30ml/kg)快速输入诱导亚低温,观察其降温效果、安全性及对重型颅脑损伤的影响。方法 50例重症颅脑外伤患者随机分为亚低温组(n=25)和常规组(n=25),亚低温组在常规治疗的基础上给予亚低温治疗。亚低温组在治疗前及诱导后1h,监测体温、平均动脉压、中心静脉压、颅内压、血气分析、血电解质、血糖、血细胞分析、凝血功能等变化。伤后6个月根据GOS分级评分判定疗效。结果诱导亚低温1h后患者体温与治疗前相比明显下降(P<0.01),平均动脉压、中心静脉压、pH值升高(均P<0.05),PaO2降低(P<0.05),血钾、血糖降低(均P<0.05),氯化物升高(P<0.01)。亚低温组颅内压在治疗1d、2d、3d、4d与同期常规组相比均明显降低。伤后6个月亚低温组预后良好率明显高于常规组(P<0.05)。结论快速输入4℃生理盐水(30ml/kg)诱导亚低温是一种安全、有效、迅速的降温方法。亚低温治疗能够改善重型颅脑外伤的预后。

Objective To induce mild hypothermia and examine the cooling effect,security and influence of severe traumatic brain injury by rapid infusion of 4℃ saline fast （30 ml/kg）. Methods Fifty cases of severe traumatic brain injury patients were randomly separated into mild hypothermia group （ n = 25 ） and the conventional group（n = 25）. On the basis of the conventional treatment, fast infusing cold 4℃ saline was used in mild hypothermia group. Temperature, MAP, CVP, ICP, blood gas analysis, electrolyte, blood glucose, blood ceil analysis and coagulation function were checked before treatment and 1 h after completion of 4 ℃ saline infusion in mild hypothermia group. Finally we evaluated the curative effect by GOS after 6 months in both groups. Results Compared to pretherapy,the mild hypothermia group＇s temperature was declined siguificantly（P 〈0. 01 ）. MAP, CVP, chloride and pH were increased（P 〈 O. 05 or P 〈 0. 01 ）, but PaO2, serum potassium, and blood glucose were reduced（ P 〈 0. 05）, simultaneously. The hypothermia group intracranial pressure in the treatment of 1 d, 2 d, 3 d, 4 d was significantly lower compared with the same period in the conventional group. The mild hypotherrnia group with good prognosis was significantly higher than routine group. Conclusions Dropping in 4 ℃saline solutio （30 ml/kg）quickly is an effective treatment method and better to prognosis for severe traumatic brain injury. Rapid infusion of 4℃ saline is a safe, effective and quick mean of lowering body temperature. Mild hypothermia therapy can improve the prognosis of severe traumatic brain injury.