探讨不同复温速度对重症颅脑外伤患者亚低温治疗愈后的研究

Study on Explore the Effect of Different Rewarming Speed on the Recovery of Mild Hypothermia in Patients with Severe Craniocerebral Injury

目的:探讨不同复温速度的亚低温治疗对重症颅脑外伤患者预后的影响。方法:回顾性分析2019年6月1日-2020年6月1日本院60例重症颅脑外伤患者的临床资料,依据亚低温治疗的复温速度分为A组(0.2℃/h,n=20)、B组(0.3℃/h,n=20)和C组(0.4℃/h,n=20)三组。比较复温开始、达标时三组患者的生命体征、实验室检查结果、脑血流、颅内压、神经功能及治疗后并发症发生情况。结果:复温达标时,A组患者的脉搏低于B组、C组(P<0.05);复温达标时,A组患者的平均动脉压低于B组、C组(P<0.05),B组患者的平均动脉压低于C组(P<0.05)。A组患者复温达标时的血小板、GCS评分均高于B组、C组(P<0.05);A组、B组患者复温达标时的颅内压均低于C组(P<0.05)。复温达标时,A组患者右额叶、左额叶、右颞叶、左颞叶、右颞顶交界、左颞顶交界、右顶叶、左顶叶、右海马、左海马的CBF数值均低于B组、C组(P<0.05),B组患者右额叶、左额叶、右颞叶、左颞叶、右颞顶交界、左颞顶交界、右顶叶、左顶叶、右海马、左海马的CBF数值均低于C组(P<0.05)。A组、B组患者的肺部感染、黏膜水肿及出血、压疮、胃潴留、下肢深静脉血栓、心律失常发生率均低于C组(P<0.05);但A组、B组的肺部感染、黏膜水肿及出血、压疮、下肢深静脉血栓、胃潴留、心律失常发生率比较,差异均无统计学意义(P>0.05)。结论:亚低温治疗重症颅脑外伤0.2℃/h的复温速度更能有效改善患者预后。

Objective:To explore the effect of mild hypothermia on the recovery of patients with severe craniocerebral trauma treated with different rewarming rates.Method:The clinical data of 60 patients with severe craniocerebral trauma in our hospital from June 1,2019 to June 1,2020 were retrospectively analyzed.According to the rewarming speed,they were divided into group A(0.2℃/h,n=20),group B(0.3℃/h,n=20)and group C(0.4℃/h,n=20).The vital signs,laboratory examination results,cerebral blood flow,intracranial pressure and neurological function of the three groups were compared at the beginning of rewarming and when the rewarming reached the standard,and the condition of complications after treatment.Result:When the retemperature reached the standard,the pulse of group A was lower than those of group B and group C(P<0.05),the mean arterial pressure of group A was lower than those of group B and group C(P<0.05),and that of group B was lower than that of group C(P<0.05).When the retemperature reached the standard,the platelet and GCS score in group A were significantly higher than those of group B and C(P<0.05),the intracranial pressure in group A and B were significantly lower than that of group C(P<0.05).When the retemperature reached the standard,the CBF values of right frontal lobe,left frontal lobe,right temporal lobe,left temporal lobe,right temporoparietal junction,left temporoparietal junction,right parietal lobe,left parietal lobe,right hippocampus and left hippocampus in group A were lower than those in group B and group C(P<0.05);the CBF values of right frontal lobe,left frontal lobe,right temporal lobe,left temporal lobe,right temporoparietal junction,left temporoparietal junction,right parietal lobe,left parietal lobe,right hippocampus and left hippocampus in group B were lower than those in group C(P<0.05).The incidence of pulmonary infection,mucosal edema and bleeding,pressure ulcer,gastric retention,deep venous thrombosis and arrhythmia in group A and group B were significantly lower than those in group C(P<0.05);however,there were no statistically significant differences in the incidence of pulmonary infection,mucosal edema and bleeding,pressure sores,deep venous thrombosis of lower limbs,gastric retention and arrhythmia in group A and group B(P>0.05).Conclusion:0.2℃/h mild hypothermia is more effective in improving the recovery of patients with severe craniocerebral injury after mild hypothermia treatment.