亚低温对大动脉闭塞性脑卒中动脉溶栓后早期神经功能恶化的影响

Effect of mild hypothermia on early neurological deterioration after main artery occlusive stroke with intra-arterial thrombolysis

目的:探讨亚低温对大动脉闭塞性脑卒中动脉溶栓后早期神经功能恶化(END)的影响。方法:50例动脉溶栓术后END患者随机分为亚低温组和常规组,比较两组治疗前和治疗后24 h、7 d颅内压(ICP)、中心静脉压(CVP)、平均动脉压(MAP)、血K+、凝血酶原时间(PT)、血小板计数(PLT)、中心静脉血氧饱和度(ScvO2)和NIHSS评分,用MRS评价90 d预后和病死率。结果 :(1)与治疗前比较,亚低温组7 d时NIHSS评分降低(P<0.01);24 h、7 d时ICP和ScvO2改善(P<0.05);24 h时血K+降低(P<0.05),7 d时血K+无显著差异。(2)与常规组比较,亚低温组7 d时NIHSS评分和24 h、7 d ICP和ScvO2均有改善(P<0.05)。(3)两组治疗前后CVP、MAP、PT和PLT无显著差异。(4)亚低温组90 d转归良好率高于常规组(P<0.01),病死率与常规组比较无显著差异。结论:亚低温可改善脑卒中动脉溶栓后END,虽不能降低病死率,但能给生存患者带来更好的转归。

Objective To explore effects of mild hypothermia on early neurological deterioration （END） after main arterial occlusive with intra-arterial thrombolysis. Methods Fifty patients were randomly divided into mild hypothermia and conventional group, to compared the changes of ICP, CVP, MAP, Blood K＋, PT, PLT, ScvO2 and NIHSS before- treatment and 24 h and 7 d after- treatment, prognosis and mortality were evaluated by MRS after 90 d. Results （1） Compared with pre-treatment, 7 d NIHSS of mild hypothermia group decreased （P 〈 0.01）; 24 h, 7 d ICP and ScvO2 improved significantly （P 〈 0.05）; 24 h decreased significantly （P 〈 0.05）, while 7 d blood K＋ showed no differences. （2） Compared with conventional group, mild hypothermia group 7 d NIHSS and 24 h, 7 d ICP and ScvO2 improved significantly （P 〈 0.05）. （3） The CVP, MAP, PT, and PLT showed no difference in two groups before and after-treatment. （4） Rate of good outcome in mild hypothermia group was significantly higher than conventional group in 90 days （P 〈 0.01） ; while the mortality rate showed no difference. Conclusions Mild hypothermia can obviously improve END in stroke with intraarterial thrombolysise, bring better outcome among survival patients, though can not reduce mortality.