血管内低温治疗对重型颅脑损伤标准大骨瓣减压术后患者短期疗效的影响

Effect of intravascular hypothermia on short-term efficacy of standard large bone decompressive craniectomy in patients with severe traumatic brain injury

目的观察血管内低温治疗对重型颅脑损伤(sTBI)标准大骨瓣减压术后患者的短期临床疗效。方法采用队列研究方法。选择2019年1月至2021年12月在重庆市急救医疗中心接受标准大骨瓣减压术后颅内压(ICP)>20 mmHg(1 mmHg≈0.133 kPa)的sTBI患者作为研究对象。根据术后是否实施血管内低温治疗将患者分为血管内低温治疗组和常规体温管理组。观察两组患者术后30 d病死率;收集两组患者术前和术后30 d采用改良Rankin量表(mRS)、Bathel指数评分评估的患者神经功能预后及日常生活活动能力;并比较两组患者术后30 d脑积水、颅内感染、迟发型血肿、电解质紊乱、肺部感染等并发症发生率的差异。结果共82例患者纳入研究,血管内低温治疗组38例,常规体温管理组44例。两组患者性别、年龄、受伤原因、损伤类型、术前格拉斯哥昏迷评分(GCS)、伤后入院时间等一般资料比较差异均无统计学意义。术后30 d,血管内低温治疗组病死率明显低于常规体温管理组〔7.89%(3/38)比18.18%(8/44),χ^(2)=7.283,P=0.038〕;术后30 d两组患者mRS评分(分)均较术前降低(常规体温管理组:3.26±0.16比4.86±0.35,血管内低温治疗组:2.31±0.22比4.77±0.57);且术后30 d血管内低温治疗组mRS评分较常规体温管理组降低更明显(分:2.31±0.22比3.26±0.16,P<0.05)。术后30 d两组患者Bathel指数评分(分)均较术前升高(常规体温管理组:37.03±2.25比24.37±1.96,血管内低温治疗组:45.29±1.42比23.61±3.02);且血管内低温治疗组较常规体温管理组升高更显著(分:45.29±1.42比37.03±2.25,P<0.05)。术后血管内低温治疗组与常规体温管理组并发症发生率比较差异无统计学意义〔23.68%(9/38)和22.73%(10/44),P>0.05〕。结论血管内低温治疗可降低sTBI标准大骨瓣减压术后患者病死率,改善患者神经功能和日常生活活动能力,提高患者临床短期疗效。

Objective To observe the short-term clinical effect of intravascular hypothermia on patients with severe traumatic brain injury(sTBI)after standard large bone decompressive craniectomy.Methods A cohort study was conducted.The sTBI patients with intracranial pressure(ICP)>20 mmHg(1 mmHg≈0.133 kPa)after standard large bone decompressive craniectomy in Chongqing Emergency Medical Center from January 2019 to December 2021 were selected as the research subjects.The patients were divided into two groups;an intravascular hypothermia treatment group and a routine body temperature management group according to whether after operation intravascular hypothermia was performed or not.The 30-day postoperative mortality was observed in the two groups;the neurological prognosis and activities of daily living were evaluated by the modified Rankin scale(mRS)and Bathel index scores before and 30 days after the operation in the two groups;the differences in the incidence of complications such as hydrocephalus,intracranial infection,delayed hematoma,electrolyte disturbance and pulmonary infection were compared between the two groups 30 days after operation.Results A total of 82 patients were included in the study,38 in the intravascular hypothermia treatment group and 44 in the routine body temperature management group.There were no statistical significant differences in general data such as gender,age,injury cause,injury type,preoperative Glasgow coma scale(GCS)score,and post-injury admission time between the two groups.On 30-day after operation,the mortality of the intravascular hypothermia treatment group was significantly lower than that of the routine body temperature management group[7.89%(3/38)vs.18.18%(8/44),χ^(2)=7.283,P=0.038];30 days after surgery,the mRS scores of patients in both groups were lower than those before operation(the routine body temperature management group:3.26±0.16 vs.4.86±0.35,the intravascular hypothermia treatment group:2.31±0.22 vs.4.77±0.57);and the mRS score of the intravascular hypothermia treatment group was significantly lower than that of the routine body temperature management group in 30 days after operation(2.31±0.22 vs.3.26±0.16,P<0.05).On the 30th day after operation,the Bathel index scores of both groups were higher than those before operation(the routine body temperature management group:37.03±2.25 vs.24.37±1.96,the intravascular hypothermia treatment group:45.29±1.42 vs.23.61±3.02);Compared with the routine body temperature management group,the Bathel index score in intravascular hypothermia treatment group was increased more significantly(45.29±1.42 vs.37.03±2.25,P<0.05).There was no significant difference in the incidence of complications after operation between the intravascular hypothermia treatment group and the routine body temperature management group[23.68%(9/38)vs.22.73%(10/44),P>0.05].Conclusion Intravascular hypothermia therapy can reduce the mortality of patients after sTBI standard large bone decompression craniectomy,improve their neurological function and activities of daily living,and elevate their short-term clinical efficacy.