亚低温对重型颅脑损伤患者血清MMP-9、颅内压和脑血流动力学的影响

Effect of mild hypothermia on serum level of MMP-9, intracranial pressure and cerebral blood flow dynamics in patients with severe craniocerebral injury

目的探讨亚低温（MHT）治疗重型颅脑损伤患者的临床效果。方法选择2013年1月至2014年4月收治的重型颅脑损伤患者50例，采用随机数字表法分为MHT组和对照组，各25例，均行标准大骨瓣减压术，MHT组术后1-3h行MHT治疗。对比两组治疗后1。7d血清基质金属蛋白酶-9（MMP-9）水平、颅内压（ICP）及脑血流动力学变化。结果治疗3～7d，MHT组血清MMP-9、ICP明显低于对照组（P〈0．05）。治疗后5～7d，MHT组大脑中动脉收缩期血流速度平均血流速度明显高于对照组，而其搏动指数值明显低于对照组（P〈0．05）。结论MHT治疗能有效改善重型颅脑损伤患者MMP-9、ICP及脑血流动力学等指标，具有肯定的脑保护作用。

Objective To investigate the clinical effect of mild hypothermia treatment （MHT） on the patients with severe craniocerebral injury and its mechanism. Methods Fifty patients with severe craniocerebral injury treated in our hospital from January, 2013 to April, 2014 were randomly divided into two groups of 50 patients each, i.e. control group, in which the patients were treated by standard large trauma craniotomy and conventional therapy, and observed group, in which the patients were treated by the mild hypothermia from 1 to 3 hours after the craniotomy beside the standard large trauma craniotomy and conventional therapy. The serum level of matrix metalloproteinase-9 （MMP-9）, intracranial pressure （ICP） and cerebral blood flow dynamics were determined in 2 groups and compared each other. Results The serum level of MMP-9 and ICP were significantly lower in the observed group than those in control group from 3 to 7 days after the treatment （P〈0.05）. The systolic and mean velocities of blood flow of middle cerebral artery were significantly higher in the observed group than those in control group （P〈0.05） and its pulse index was significantly lower in the observed group than that in control group （P〈0.05）. Conclusion MHT can effectively lower the serum level of MMP-9 and ICP and improve the cerebral blood flow dynamics in the patients with severe craniocerebral injury.