亚低温对重型脑损伤患者继发性脑损伤的作用评价

Effects of mild hypothermia in secondary brain injury in patients with severe brain injury

目的评估亚低温联合高压氧（hyperbaricoxygen，HBO）对重型颅脑损伤患者继发性脑损害的影响。方法本次临床试验研究为前瞻性研究，将伤后8h内入院的重型颅脑损伤患者42例，采用随机数字表法分为亚低温联合HBO的治疗组和常规HBO治疗的对照组各2l例。分别于伤后第1天、15天、30天复查头颅cT，计算脑出血量及脑水肿体积；同时进行GCS（GlasgowComaScale）评分；统计两组患者出现脑梗死的例数；伤后半年，对两组患者进行GOS（GlasgowOutcomeScore）预后评分。采用SPSS13．0统计软件，两组样本率的比较采用连续性校正的X。检验，用独立样本t检验进行组间两两比较，以P〈0．05为差异具有统计学意义。结果（1）治疗组伤后15d和30d的脑出血量和水肿体积明显小于对照组[（21．71±4．3）vs．（26．33±5．23）；（14．33±1．93）vs．（16．86±2．86），P〈0．05]；（2）伤后15d和30d治疗组GCS评分高于对照组[（4．62±0．49）vs．（4．29±0．56）；（9．76±1．37）vs．（8．57±0．92），P〈0．05]；（3）治疗组出现外伤性脑梗死2例数，而对照组9例（χ2=4．434，P=0．035）；伤后6个月，治疗组GOS评分高于对照组[（4．29±0．84）vs．（3．38±0．74），P=0．001]。结论亚低温联合高压氧治疗能够减轻重型颅脑损伤的继发性脑损伤和改善患者预后，值得临床上进一步探讨，亚低温的作用机制有待于进一步研究。

Objective To evaluate the effect of mild hypothermia combined with hypbaric oxygen （HBO） treatment on secondary brain injury in patients with severe craniocerebral injury. Methods A prospective study was conducted in this study. Forty-two patients with severe craniocerebral injury admitted to hospital within 8 hours were randomly divided into sub-hypothermia combined with HBO treatment group and conventional HBO control group, 21 cases in either group. Cerebral hemorrhage and brain edema were calculated by reviewed head CT on the 1st day, 15th day and 30th day after injury. GCS （ Glasgow Coma Scale） score was calculated at the same time. The number of cases of cerebral infarction was counted in the two groups. GOS （ Glasgow Outcome Score） prognosis was scored for both groups of patients six months after injury. Two groups of sample rates were compared using a chi-square test with continuous correction, The intergroup comparisons were analyzed by independent sample t test by using SPSS version 13.0 software. Differences were considered statistically significant if P 〈 0. 05. Results （ 1 ） The amount of cerebral hemorrhage and edema in the treatment group were significantly lower than those in the control group on the l5th day and 30th day after injury [ （21.71 ±4.3） vs. （26.33 ±5.23）; （14.33±1.93） vs. （ 16. 86 ± 2. 86）, P 〈0. 05 ] . （2） The GCS score of the treatment group was higher than that of the control group on the 15th day and 30th day after injury [ （4.62±0.49） vs. （2.49±0.56）; （9.76±1.37） vs. （ 8.57 ± 0. 92）, P 〈 0.05 ] ; （ 3 ） There were 2 eases of traumatic cerebral infarction in the treatment group and 9 cases in the control group （ χ2 = 4. 434, P = 0. 035） . The GOS score in the treatment group washigher than that in the control group six months after injury [ （4. 29 ±0. 84） vs. （3.38±0. 74）, P = 0. 001] . Conclusions Mild hypothermia combined with hyperbaric oxygen treatment can reduce the secondary brain injury and improve the prognosis of patients with severe craniocerebral injury. It is worth further study, the meehanism of hypothermia remains to be further studied.