亚低温治疗老年重型颅脑创伤患者的临床疗效

The clinical analysis of mild hypothermia therapy for severe traumatic brain injury in elderly patients

目的探讨亚低温在治疗老年重型颅脑创伤患者的临床疗效。方法将经急诊抢救的72例老年重型颅脑创伤患者（GCS≤8分）按照随机数字表法分为亚低温组（36例）和对照组（36例），亚低温组行亚低温治疗，对照组行常温治疗，分析上述两组患者的临床预后情况。结果治疗后24h两组颅内压开始上升，但亚低温组患者治疗后24h，3d，5d的颅内压值[（13．0±4．5）mmHg，（16．6±4．0）mmHg，（19．9±3．9）mmHg，1mmHg：0．133kPa]明显低于对照组患者[（16．6±3．8）mmHg，（20．4±4．8）mmHg，（24．1±6．2）mmHg]，差异有统计学意义（t=2．225，2．260，2．192，P=0．035，0．033，0．039）。对照组和亚低温组的恢复良好率分别为22．22％和47．22％，对照组和亚低温组的死亡率分别为30．56％和13．89％，差异有统计学意义（x。4．936，5．675，P=0．047，0．035）。结论亚低温治疗可以抑制颅内压升高，降低老年重型颅脑创伤患者的致残率和死亡率，从而提高患者的生存率，改善远期预后。

Objective To investigate the clinical therapeutic effect of mild hypothermia in elderly patients with severe traumatic brain injury. Methods 72 cases of elderly patients with severe traumatic brain injury（GCS≤8） were divided into mild hypothermia therapy group（ 36 patients）and control group（ 36 patients） according to the random number table method. Mild hypothermia therapy group received mild hypothermia treatment while control group received normal treatment.The clinical prognosis was analyzed between the two groups. Results After 24h treatment, both mild hypothermia therapy group and control group intracranial pressure began to rise.But the intracranial pressure of the mild hypothermia therapy group （24 h： （ 13.0±4.5）mmHg,3 d： （16.6±4.0） mmHg,5 d： （19.9±3.9） mmHg, 1 mmHg= 0.133 kPa） were significantly lower than those of the control group（24 h： （16.6±3.8） mmHg,3 d： （20.4±4.8） mmHg;5 d： （24.1± 6.2） mmHg）, and the difference was statistically significant （ t = 2.225,2.260,2.192, P= 0.035,0.033, 0.039） .The rate of good recovery to the control group and the mild hypothermia therapy group were 22.22% and 47.22% respectively while the mortality were 30.56% and 13.89% respectively, and the differences were statistically significant （ χ^2 = 4.936,5.675, P= 0.047,0.035）. Conclusion Mild hypothermia treatment can inhibit the increase of intracranial pressure and reduce disability rate and mortality in elderly patients with severe traumatic brain injury, which can increase the survival rate and improve the long-term prognosis.