早期亚低温治疗原发性脑干出血疗效分析

Effect of early mild hypothermia on primary brainstem hemorrhage

目的探讨早期亚低温治疗原发性脑干出血的疗效、预后及临床价值。方法138例原发性脑干出血患者随机分为亚低温组70例和对照组68例,对照组给予常规治疗,亚低温组在常规治疗的基础上给予早期亚低温治疗。比较2组患者14 d病死率、并发症发生情况,评估治疗前和治疗7、14 d后格拉斯哥昏迷评分(Glasgow coma scale,GCS)及治疗6个月后格拉斯哥结局量表评分(Glasgow outcome score,GOS)。结果治疗14 d后,亚低温组病死率(22.9%)低于对照组(39.7%)(P<0.05),并发症发生率(65.7%)与对照组(57.4%)比较差异无统计学意义(P>0.05);治疗7、14 d后,亚低温组GCS评分[(8.96±2.03)、(9.36±3.27)分]明显高于对照组[(7.81±2.69)、(8.14±2.09)分](P<0.05);治疗6个月后,2组GOS评定分级比较差异有统计学意义(P<0.05),亚低温组预后良好率(25.7%)高于对照组(11.8%)(P<0.05),病死率(28.6%)低于对照组(45.6%)(P<0.05)。结论早期亚低温治疗原发性脑干出血可降低急性期病死率,提高患者意识水平,改善远期预后。

Objective To investigate the effect,prognosis and clinical value of early mild hypothermia in the treatment of primary brainstem hemorrhage.Methods Totally 138 patients with primary brainstem hemorrhage were randomly divided into mild hypothermia group(n=70)and control group(n=68).Besides the conventional treatment in both groups,mild hypothermia group received early mild hypothermia therapy.The mortality and complications were compared between two groups.The Glasgow coma scale(GCS)before treatment and after 7-and 14-day treatment as well as the Glasgow outcome scale(GOS)score after 6-month treatment were evaluated.Results The mortality was lower in mild hypothermia group(22.9%)than that in control group(39.7%)after 14-day treatment(P<0.05),and there was no significant difference in the incidence of complications between two groups(65.7%vs.57.3%)(P>0.05).The GCS scores were higher in mild hypothermia group(8.96±2.03,9.36±3.27)than those in control group(7.81±2.69,8.14±2.09)after 7-and 14-day treatment(P<0.05).The GOS score showed a significant difference after 6-month treatment between two groups(P<0.05).The good prognosis rate was higher in mild hypothermia group(25.7%)than that in control group(11.8%)(P<0.05),and the mortality was lower in mild hypothermia group(28.6%)than that in control group(45.6%)(P<0.05).Conclusion Early mild hypothermia treatment can reduce the mortality rate in early stage,improve the consciousness,and benifit the long-term outcome in patients with primary brainstem hemorrhage.