摘要
目的 比较亚低温与醒脑静注射液对急性重型颅脑创伤患者的临床疗效。方法 164例急性重型颅脑创伤患者,随机分为亚低温组(54例)、醒脑静组(55例)和常规治疗组(55例)。亚低温组于伤后24h内行亚低温治疗,直肠温度与脑组织温度分别控制在32.5℃～34.9℃和32℃～35℃,维持1～7 d,平均(54.5±26.4)h;同时监测生命体征、颅内压、血糖、血乳酸、血气、血电解质以及脑组织氧分压和脑温。醒脑静组予以醒脑静注射液20～40 ml,静脉滴注,1次/d,疗程14d;直肠温度控制在36.5℃～37.5℃。常规治疗组直肠温度控制在36.5℃～37.5℃。3组患者均于伤后3个月根据GOS标准判定疗效。结果 亚低温组于治疗后早期(24 h内)颅内压、血糖及高乳酸血症等异常指标分别下降(均P<0.05);血浆Mg^(2+)水平升高(P<0.05或P<0.01);脑组织氧分压迅速升高并维持于正常水平,与其他两组比较差异有显著性意义(均P<0.05)。3组间生命体征、血气及其他血电解质变化差异无显著性意义(P>0.05)。亚低温组无一例发生严重并发症,且病死率、伤后恢复良好率及患者预后均显著优于其他两组(均P<0.05)。醒脑静组恢复良好率及颅内压下降程度较常规治疗组明显改善(均P<0.05)。结论(1)应用亚低温治疗急性重型颅脑创伤患者疗效优于醒脑静注射液,可降低病死率,提高生存?
Objective The clinical effects of mild hypothermia and Xingnaojing injection on severe brain injury were studied and compared. Methods All 164 cases with acute severe brain injury (Glascow coma scale ≤ 8 on admission) were randomly divided into mild hypothermia group (54 cases), Xingnaojing group (55 cases) and routine treatment group (55 cases). Hypothermia was induced within 24 hours after injury. The rectal temperature and brain temperature were kept at 32.5℃-34.9℃ and 32.8 ℃-35℃, respectively for 1-7 days [average (54.5±26.4) hours]. Meanwhile, the vital signs, intracranial pressure, blood glucose and lactate, blood gas level, blood electrolytes, brain tissue oxygen partial pressure, and brain tissue temperature were monitored. All cases in Xingnaojing group were intravenously infused Xingnaojing injection 20-40ml in 500ml 10% glucose or 0.9% sodium chloride once daily, and the rectal temperature was kept at 36.5 ℃-37.5℃ for 14 days. The routine treatment group patient's rectal temperature was kept at 36.5 ℃-37.5℃. The therapeutic effect of all the patients was evaluated at the 3rd month after injury according to Glascow outcome scale. Results In comparison with Xingnaojing group and the routine treatment group, the increased intracranial pressure, hyperglycemia and blood lactate level decreased significantly, Mg2 + concentration raised to a certain extent respectively in mild hypothermia group (P<0.05 or P<0.01). The brain tissue oxygen partial pressure was raised rapidly and maintained at normal level. The vital signs, blood gas values and blood electrolytes (except Mg2+) did not change significantly. The mortality decreased and good recovery rate increaesd, the prognosis of the patients improved significantly (P<0.05) in hypothermia group. In comparison with the routine treatment group, the increased intracranial pressure decreased significantly (P< 0.05) and the good recovery rate increased in Xingnaojing group (P<0.05). Conclusion 1) Mild hypothermia is more effective than xingnaojing injection in the treatment of severe brain injury, it can reduce the mortality and improve the prognosis without severe complications. The Xingnaojing injection has a certain effect on decreasing the increased intracranial pressure. 2) The therapy of mild hypothermia is effective within 24 hours after brain injury, thus in patients with acute severe brain injury, mild hypothermia therapy should be performed earlier and supplemented with Mg2+ in time. 3) Monitoring of brain tissue oxygen partial pressure and brain tissue temperature is important for mild hypothermia therapy.
