摘要
目的 探索亚低温脑保护在高血压脑出血治疗中应用的可行性及疗效。方法 85例高血压脑出血患者分为(1)亚低温治疗组:31例,其中脑出血分级Ⅱ级者1例,Ⅲ级9例,Ⅳ～Ⅴ级21例,于伤后24h内接受轻度低温治疗,直肠温度维持在33℃～35℃,颅内压在20mmHg以下者,治疗时间为24h;颅内压高于20mmHg者治疗72h;而颅内压持续在30mmHg以上或在短时间内迅速增高者行CT检查,以确定是否有颅内血肿形成。(2)常规治疗组:54例,脑出血分级Ⅱ级者2例,Ⅲ级16例,Ⅳ～Ⅴ级36例,于伤后24h内以常规药物治疗。根据GOS预后评估系统评价两组患者疗效。结果 经治疗后,亚低温组轻残8例、中残11例、重残4例、植物生存3例,死亡5例,恢复良好率为25.81％(8/31),与常规治疗组比较差异有显著性意义(P<0.05)。结论 亚低温具有减轻高血压脑出血患者脑水肿、降低颅内压、防止神经细胞凋亡的作用。可提高高血压脑出血患者的生存率及生存质量。
Objective To study the feasibility and effect of mild hypothermia for brain protection in treatment of hypertensive cerebral hemorrhage. Methods A total of 85 patients with hypertensive cerebral hemorrhage were divided into 2 groups, mild hypothermia therapeutic group (MHTG, 31 cases) and conventional therapeutic group (CTG, 54 cases). By cerebral hemorrhage grading, there were patients with grade Ⅱ
1 case, grade Ⅲ 9 cases and grade Ⅳ-Ⅴ 21 cases in MHTG; grade Ⅱ 2 cases, grade Ⅲ 16 cases and grade Ⅳ-Ⅴ 36 cases in CTG. In MHTG, mild hypothermia was performed in 24 hours after injury. The treatment durations were 24 hours for the patients of rectal temperature kept at 33 ℃-35 ℃ intracerebral pressure (ICP) < 20 mmHg; 72 hours for the patients of ICP > 20 mmHg. CT examination was performed in the patients of ICP > 30 mmHg or rapidly incresed ICP in a short time for detecting intracranial hematoma. In CTG conventional drugs were administered in 24 hours after injury. The therapeutic effects were evaluated by GOS in the
2 groups. Results After treatment, there were mild disablement 8 cases, moderate disablement 11 cases, severe disablement 4 cases and death 5 cases; good recover rate 25.81% (8/31) in MHTG. The difference was significant (P<0.05) compared with that in CTG. Conclusion Mild hypothermia has the effects on decreasing cerebral edema, ICP and protecting from nerve cell apoptosis. Thus it can improve the survival rate and life quality of patients with hypertensive cerebral hemorrhage.
