摘要
目的 观察亚低温治疗弥漫性轴索损伤患者的疗效。方法 36例GCS≤8分的弥漫性轴索损伤患者,于创伤后24h内接受亚低温治疗。直肠温度控制在32℃～34℃,当颅内压降至正常范围后再维持低温治疗24～48h,然后缓慢复温;监测和记录治疗前后的脑组织氧分压、颅内压、血气及重要脏器功能指标,于伤后3个月根据GOS标准进行评估,并与对照组比较。结果 亚低温治疗后,患者脑组织氧分压增高(P<0.05),颅内压降低(P<0.05),对创伤后早期发生的高血糖反应具有抑制作用(P<0.05)。GOS评估结果显示,亚低温组患者恢复良好率为52.78％,病死率27.78％,与对照组相比差异有显著性意义(均P<0.05)。结论 采用持续24～48h亚低温治疗弥漫性轴索损伤患者安全、有效,无严重并发症,可降低病死率、改善预后。
Objective To study the therapeutic effects of mild hypothermia in patients with diffuse axonal injury (DAI). Methods Mild hypothermia treatment was applied in 36 patients with DAI within 24 hours after injury, the patients' Glasgow coma scale was ≤8 at admission. The rectal temperature was kept at 32 t-34 t and lasted 24-48 hours after the intracranial pressure lowering into normal range, then the patients were rewarmed within 12 hours. The oxygen partial pressure of brain tissue (PbtO2), intracranial pressure (ICP), blood gas and parameters of vital organ functions were simultaneously monitored and recorded pre-and post-treatment. Prognosis was evaluated with Glasgow outcome scale (GOS) at 3 months after injury and compared with that in control group. Results The mild hypothermia treatment significantly elevated PbtO2 (P <0.05) and reduced ICP (P<0.05) compared with controls, and the increasing blood glucose level responsed at the early stage after injury was inhibited (P < 0.05) compared with controls. The GOS assessment indicated that 52.78% of the patients who received mild hypothermia treatment had good recovery, and mortality rate was 27.78%. There were significant differences (bothP<0.05) compared with controls (31.25% and 37.50% respectively). Conclusion The continuous mild hypothermia treatment (24-48 h) is safe and effective for DAI patients, it can improve prognosis, lowering mortality without any serious complications.
