重症颅脑外伤亚低温治疗时复温速度的选择

Selection of rewarming rate in the treatment of severe craniocerebral trauma with mild hypothermia

目的探究重症颅脑外伤亚低温治疗时的最佳复温速度。方法选取我院2018年1~12月收治的亚低温治疗重症颅脑外伤患者90例,随机将患者分为A、B、C三组,以亚低温治疗仪实施复温控制,A组复温速度为0.2℃/h、B组复温速度为0.3℃/h,C组复温速度为0.4℃/h,比较三组复温前后的颅内压(ICP)、心率(HR)、神经功能缺损评分(NIHSS),治疗后的GOS疗效评级,以及复温前、复温后12、24及72h的大脑中动脉血流速度。结果复温前三组患者的颅内压、心率、NIHSS评分和大脑中动脉血流速度差异无统计学意义(P>0.05),复温后A组的心率高于B、C组(P<0.05),颅内压及神经功能缺损评分低于B、C组(P<0.05),治疗优良率及复温后12、24及72h的大脑中动脉血流速度高于B、C组(P<0.05)。结论较慢的复温速度可有效改善患者脑灌注,减轻脑水肿,保护其神经功能,同时可改善疾病预后。

Objective To investigate the optimal rewarming rate in the treatment of severe craniocerebral trauma with mild hypothermia.Methods 90 patients with severe craniocerebral trauma treated with mild hypothermia admitted and treated in our hospital from January to December 2018 were selected,and divided into groups A,B and C using the random method.A mild hypothermia therapeutic apparatus was used to perform rewarming control.The rewarming rate was 0.2℃/h in group A,0.3℃/h in group B,and 0.4℃/h in group C.The intracranial pressure(ICP),heart rate(HR),and neurologic impairment score(NIHSS)before and after rewarming,the GOS efficacy rating after treatment,and blood flow velocity in middle cerebral artery before rewarming,and at 12h,24h and 72h after rewarming of the three groups were compared.Results There was no significant difference in the intracranial pressure,heart rate,NIHSS score,and blood flow velocity in middle cerebral artery in the three groups of patients before rewarming(P>0.05);After rewarming,the heart rate in the group A was higher than that in the groups B and C(P<0.05);The intracranial pressure and neurologic impairment score were lower than those in the groups B and C(P<0.05);The excellent therapy rate and blood flow velocity in middle cerebral artery at 12h,24h and 72h after rewarming were higher than those in the groups B and C(P<0.05).Conclusion Slower rewarming rate can effectively improve patients'cerebral perfusion,reduce cerebral edema,protect their neurological function,and improve prognosis of disease.