亚低温辅助治疗对颅脑外伤患者去骨瓣减压术后恢复情况的影响被引量：12

Effect of mild hypothermia auxiliary therapy on recovery of patients with craniocerebral trauma after decompressive craniectomy

下载PDF

导出

摘要目的：分析亚低温辅助治疗对颅脑外伤患者去骨瓣减压术后恢复情况的影响。方法：选取2012年11月~2014年11月在我院接受去骨瓣减压治疗的110例颅脑外伤患者作为研究对象，根据治疗方式不同随机分为观察组及对照组，各组55例。对照组患者接受单纯去骨瓣减压术，观察组患者接受去骨瓣减压术联合亚低温辅助治疗，对比两组患者的神经功能，血清神经元特异性烯醇化酶（NSE）、超氧化物歧化酶（SOD）、一氧化氮（NO）、内皮素（ET）水平，脑血流水平，血清抗利尿激素（ADH）、脑利钠肽（BNP）、促肾上腺皮质激素（ACTH）水平等差异。结果：观察组接受亚低温辅助治疗后1周的大脑神经功能分级（CPC）低于对照组，格拉斯哥预后评分（GOC）及欧洲卒中评分量表（ESS）评分值高于对照组（P〈0．05）；观察组接受治疗1周后的血清NSE、NO、ET水平低于对照组，SOD水平高于对照组（P〈0．05）；观察组接受治疗后1周，收缩期血流速度（Vs）、平均血流速度（Vrn）水平高于对照组，搏动指数（PI）水平低于对照组（P〈0．05）；观察组接受治疗后1周，血清抗利尿激素（ADH）、促肾上腺皮质激素（ACTH）水平低于对照组，脑利钠肽（BNP）水平高于对照组（P〈0．05）。结论：去骨瓣减压术联合亚低温辅助治疗，可以有效改善患者的神经功能、提升脑血流，优化体液相关因子水平，具有积极的临床意义。 Objective： To analyze the effect of mild hypothermia auxiliary therapy on recovery of patients with cranioce- rebral trauma after decompressive craniectomy. Methods： A total of 110 cases of patients with craniocerebral trauma who re- ceived decompressive craniectomy in our hospital from November 2012 to November 2014 were selected as research subjects and randomly divided into observation group and control group according to different treatment methods, with 55 cases in each group . Control group received decompressive craniectomy alone, while observation group received decompressive craniectomy combined with mild hypothermia auxiliary therapy, and then differences in neural function, serum NSE, SOD, NO and ETlevels, cerebral blood flow level as well as serum ADH, BNP and ACTH levels of two groups were compared. Results： CPC grading of observation group 1 week after mild hypothermia auxiliary therapy was lower than that of control group and scores of GOC and ESS were higher than those of control group （P〈0.05） ; serum NSE, NO and ET levels of observation group 1 week after treatment were lower than those of control group and SOD level was higher than that of control group （P〈0.05） ; Vs and Vm levels of observation group 1 week after treatment were higher than those of control group and PI level was lower than that of control group （P〈0.05） ; serum ADH and ACTH levels of observation group 1 week after treatment were lower than those of control group and BNP level was higher than that of control group （P〈0.05）. Conclusions, Decompressive crani- ectomy combined with mild hypothermia auxiliary therapy for patients with craniocerebral trauma can effectively improve pa- tients＇ neural function, promote cerebral blood flow and optimize humoral-associated factor levels, and it has positive clinical significance.

作者杜江

机构地区湖北省黄冈市英山县人民医院急诊科

出处《海南医学院学报》 CAS 2016年第5期453-456,459,共5页 Journal of Hainan Medical University

基金湖北省卫生厅科研基金资助课题(2007JX3B54)~~

关键词颅脑外伤去骨瓣减压术亚低温辅助治疗 Craniocerebral trauma Deeompressive craniectomy Mild hypothermia auxiliary therapy

分类号 R651.1 [医药卫生—外科学]

引文网络
相关文献

参考文献15

1Miyauchi T, Wei EP, Povlishock JT. Evidence for the thera- peutic efficacy of either mild hypothermia or oxygen radical scavengers after repetitive mild traumatic brain injury[J]. J Neurotrauma, 2014, 31(8): 773-781.
2殷玉华,李明,贾锋,江基尧,徐蔚.亚低温干预对创伤性颅脑损伤后N-甲基-D-天冬氨酸受体1表达的影响[J].上海医学,2013,36(4):361-365. 被引量：11
3Kim F, Nichol G, Maynard C, et al. Effect of prehospital in- duction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial[J]. JAMA, 2014, 311(1): 45- 52.
4Zawi lak B, Depukat R, Arif S, et al. Mild induced hypother mia in patient with acute myocardial infarction after cardiac ar rest[J]. KardiolPol, 2013, 71(4): 426-428.
5张晓辉,贾敏,韩劲松,赵明,李安民.去骨瓣减压术治疗恶性大脑中动脉梗死的研究进展[J].天津医药,2015,43(9):1082-1085. 被引量：7
6Kim JY, Kim N, Yenari MA, et al. Hypothermia and pharma- cological regimens that prevent overexpression and overactivity of the extracellular calcium-sensing receptor protect neurons a gainst traumatic brain injury[J]. J Neurotrauma, 2013, 30 (13) : 1170-1176.
7Yokobori S, Gajavelli S, Mondello S, et al. Neuroprotective effect of preoperatively induced mild hypothermia as determined by biomarkers and histopathological estimation in a rat sub- dural hematoma decompression model[J]. J Neurosurg, 2013, 118(2) : 370-380.
8保学明,卢建华,余涛,林俊敏.亚低温对恢复自主循环后患者预后和脑功能的影响[J].实用医学杂志,2015,31(3):381-384. 被引量：11
9Mena JH, Sanchez AI, Rubiano AM, et al. Effect of the modi- fied Glasgow Coma Scale score criteria for mild traumatic brain injury on mortality predictiom comparing classic and modified Glasgow Coma Scale score model scores of ls[J]. J Trauma, 2011, 71(5): 1185- 1192.
10Suehiro E, Fujisawa H, Koizumi H, et al. Significance of differences between brain temperature and core temperature (δ T) during mild hypothermia in patients with diffuse axonal in- jury[J]. Neuroi MedChir (Tokyo), 2011, 51(8): 551-555.

二级参考文献73

1Ramani R. Hypothermia for brain protection and resuscita-tion [J]. Curr Opin Anaesthesiol, 2006, 19(5): 487-491.
2Bayir H, Clark RS, Kochanek PM. Promising strategies to mini-mize secondary brain injury after head trauma [J]. Crit CareMed,2003, 31(1): 112-117.
3Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy re-duces blood glucose and lactate and improves neurologic out-comes in patients with severe traumatic brain injury [J]. J CritCare, 2011,26(3): 311-315.
4Jiang JY. Clinical study of mild hypothermia treatment for se-vere traumatic brain injury [J]. J Neurotrauma, 2009, 26(3):399-406.
5Lee HC, Chuang HC, Cho DY, et al. Applying cerebral hypo-thermia and brain oxygen monitoring in treating severe trau-matic brain injury [J]. World Neurosurg, 2010, 74(6): 654-660.
6Wang J, Hoe Zhiwei F,et al. Apoptosis and traumatic brain inju-ry [J]. Neurocrit Care, 2005,47(3): 177-182.
7Ziegler D, Cravens G, Angles G, et al. Use of transcranialDoppler in patients with severe traumatic brain injury [J]. CritCare, 2010, 14,(1):292.
8Jia F, Mao Q, Liang YM,et al. Effect of post-traumatic mildhypothermia on hippocampal cell death atter traumatic brain in-jmy in rats [J]. J Neurotrauma, 2009, 26(2): 243-252.
9Yablon JS, Lantner HJ, McCormack TM, et al. Clinical experi-ence with a fiberoptic intracranial pressure monitor patientsmonitored with a fiberoptic intracranial pressure device is de-scribed [J]. J Clin Monit Comput, 1993, 9(3): 171-175.
10Masaoka H. Cerebral blood flow and metabolism during mildhypothermia in patients with severe traumatic brain injury [J].J Med Dent Sci, 2010,57(2): 133-138.