血管内降温治疗重型颅脑损伤的临床研究

Clinical study of intravascular hypothermia for severe traumatic brain injury

目的研究血管内降温治疗重型颅脑损伤的临床效果。方法将51例重型颅脑损伤病人随机分为对照组（n=20）,传统亚低温组（n=20）和血管内降温组（n=11）。两个治疗组31病人均于伤后20 h内使直肠温度降至33~34℃,治疗持续4~7 d,当颅内压降至正常后24 h,停止亚低温治疗。同时床旁监测生命体征、颅内压等。根据GOS评估法判定疗效。结果三组病人的年龄及GCS评分等临床特征无明显统计学差异（P〉0.05）;伤后第7天,两组亚低温治疗的病人颅内压明显低于对照组（P〈0.05）,且基本降至正常。经6个月随访,两组亚低温治疗病人的病死率明显低于对照组,恢复良好率显著高于对照组（P〈0.05）。结论血管内降温治疗重型颅脑损伤与传统亚低温治疗效果相似,其可减少肌松药和镇静药的使用及机械通气所带来的并发症。该方法治疗重型颅脑损伤安全、有效。

Objective To study the clinical effect of intravascular hypothermia for the patients with severe traumatic brain injury. Methods A total of 51 severe traumatic brain injury patients were randomly divided into the control group （n = 20）, traditional mild hypothermia （TMH） group （n = 20） and intravascular hypothermia （WH） group （n=11）. The rectal temperature （RT） was induced to 33 to 34℃ by hypothermia within 20 h of injury and lasted for 4 to 7 d in TMH and IVH groups. The treatment was stopped at 24 h after intracranial pressure （ICP） decreasing to normal level. Meanwhile, the vital sign and ICP were measured at the bed side. The prognosis of the patients was judged according to glasgow outcome scale （GOS）. Results There was no significant difference in age and the initial glasgow coma score between the 3 groups （P 〉 0.05）. In TMH and IVH groups, the mean ICP of patients was lower than control group and decreased to normal level （P 〈 0.05） 7 d after injury, and the mortality was significantly lower, while recovery rate was significantly higher than the control group （P 〈 0.05）. Conclusion The therapeutic effect of IVH is similar to TMH for severe traumatic brain injury, furthermore it can reduce employment of muscle relaxants and sedative drugs and avoid the complications secondary to mechanical ventilation, thus being a safe and effective method.