亚低温治疗对脑出血所致MODS的影响

The Effects of Mild Hypothermia on MODS Caused by Cerebral Hemorrhage

目的分析全身亚低温治疗对脑出血所致MODS的影响及全身亚低温技术的临床价值.方法选取同济大学附属上海市东方医院重症监护室于2012年1月至2015年12月收住院的脑出血后并发MODS患者180例,随机分为观察组和对照组,对照组采用常温(normothermic,NT)治疗,观察组采用全身亚低温治疗(whole body mild hypothermia,WHT)治疗,观察对比2组患者治疗后的MODS评分、氧耗(oxygen consumption,VO2)与氧供(oxygen delivery,DO2)比值、ICU住院时间、机械通气时间、癫痫发生率及病死率、卒中量表评分和巴氏指数评分.结果观察组患者经治疗后MODS评分、氧耗与氧供状况均显著优于对照组,差异有统计学意义(P<0.05);观察组患者症状ICU住院时间和机械通气时间和对照组相比更短,差异有统计学意义(P<0.05);观察组患者经治疗后的癫痫发生率和病死率均显著少于对照组,差异有统计学意义(P<0.05);观察组患者的卒中量表评分和巴氏指数评分均显著优于对照组患者,差异有统计学意义(P<0.05).结论全身亚低温技术对于脑出血所致MODS有着重要的临床意义,可以有效改善MODS患者的氧供需平衡,延缓MODS患者病情的进展,改善预后,值得在临床中应用推广.

Objective To disscuss and analyze the clinical effects of whole body mild hypothermia on MODS caused by cerebral hemorrhage. Methods One hundred and eighty patients with MODS caused by cerebral hemorrhage during the period of hospitalized from January 2013 to December 2015 in ICU of our hospital were divided into two groups （observation group and control group） randomly, 90 cases patients in each group. Patients in control group were treated with conventional treatment intervention, patients in control group were treated with whole body mild hypothermia on the base of conventional treatment intervention, the score of MODS, the ratio of, V02 and DO2, the time during the period of hospitalized in [CU, the time of mechanical ventilation, epilepsy incidence and mortality, NIHSS score and PADL score of the patients in these two group after treatment were compared. Results After the comparion, the score of MODS and the state of oxygen consumption and oxygen supply of the patients in observation group were better than the patients in control group, there was significant differences, and had statistical significance （P〈0.05） ; the time during the period of hospitalized in ICU and the time of mechanical ventilation of the patients in observation group were shorter than the patients in control group,there was significant difference, and had statistical significance （P〈0.05） ; the mortality were reduce significantly of the patients in observation group than the patients in control group, there was significant difference, and had statistical significance （P〈0.05） ; the epilepsy incidence of the patients in observation group and control has no significant difference, has no statistical significance P〉0.05） ; the NIHSS score and PADL score of the patients in observation group were higher than the patients m control group, there was significant difference, and has statistical significance （P〈0.05）. Conclusion The clinical effects of whole body mild hypothermia on MODS caused by cerebral hemorrhage have important significance, can effectively improve the balance of multiple organ dysfunction syndrome patients, can delay the progression of multiple organ dysfunction syndrome patients, improve the prognosis, it is worthy of clinical application and promotion.