重型颅脑损伤去骨瓣减压术后颅内压升高的亚低温治疗

Mild hypothermia treatment of intracranial hypertension after decompressive craniectomy in patients with severe traumatic brain injury

目的 探讨亚低温治疗对重型颅脑损伤去骨瓣减压术后持续性颅内压升高的效果及安全性。方法 回顾性分析48例重型颅脑损伤去骨瓣减压术后仍存在持续性颅内压升高的临床资料,根据减压术后治疗方法分为亚低温组（22例,进行亚低温治疗）和常温组（26例,维持正常体温）。结果 与术后1 d相比,术后2～4 d,两组颅内压均呈明显下降趋势（P〈0.05）,脑灌注压均呈明显增高趋势（P〈0.05）,而且亚低温组变化更明显（P〈0.05）。亚低温组肺部感染和水电解质紊乱发生率均明显高于常温组（P〈0.05）。伤后6个月,亚低温组GOS评分1分2例,2分8例,3分4例,4分2例,5分6例;常温组1分8例,2分10例,3分4例,5分4例;两组预后无统计学差异（P〉0.05）。结论 亚低温治疗能有效缓解重型颅脑损伤去骨瓣减压术后颅内压增高。

Objective To evaluate the curative effects of mild hypothermia on the intraeranial hypertension after the decompressive cranieetomy and its safety in patients with severe traumatic brain injury （sTBI）. Methods The clinical data of 48 sTBI patients with intracranial hypertension after the decompressive craniectomy, who were divided into mild hypothermia group （n=22） and control group （n=26）, were analyzed retrospectively. The curative effects were compared between both the groups. Results The intracranial pressures （ICPs） 2, 3 and 4 days after the operation were （21.09±1.18） mmHg, （19.09±0.74） mmHg and （18.27±0.88） mmHg respectively in the mild hypothermia group and （27.00±1.16） mmHg, （25.26±1.13） mmHg and （21.80±1.37） mmHg respectively in the control group. The cerebral perfusion pressures （CCPs） 2 and 3 days after the operation were （75.63 ±0.82） mmHg and （77.18 ±1.23） mmHg respectively in mild hypothermia group and （69.88±1.85） mmHg and （71.42±2.03） mmHg respectively in the control group. There were significant differences in the above-mentioned ICPs and CCPs between the two groups （/9〈0.05）. The rates of pulmonary infection （54.5%, 12/22） and electrolyte disturbances （59.1%, 13/22） were significantly higher in the mild hypotherrnia group than those [（23.1%, 6/26） and （26.9%, 7/26） respectively] in the control group （P〈0.05）. Conclusions The results suggested that mild hypothermia therapy can lower the intracranial hypertension after the decompressive craniectomy and probably increase the risks of pulmonary infection and electrolyte disturbances in the patients with TBI.