亚低温治疗重型颅脑损伤的临床应用及脑氧代谢研究

Treatment of severe head injury with mild hypothermia and study of metabolism of brain

目的 探讨亚低温疗法对重型颅脑损伤患者的脑保护机理及临床疗效。方法 112例重型颅脑损伤患者 (GCS≤ 8分 )随机分为亚低温治疗组和常温治疗组。亚低温组 6 5例 ,于伤后 4～ 12小时内行亚低温治疗 ,术中将脑温探头置于硬膜下腔 ,将脑温控制在 32～ 35℃。亚低温治疗 4～ 7天 ,同时检测颈动脉和颈静脉血气及电解质变化、颅内压 (ICP)、血糖及生命体征等指标。常温组除未行亚低温治疗外 ,其余治疗及监测方法同亚低温组。两组病人均于伤后 3个月根据GOS预后评分判定疗效。结果 与常温组比较 ,亚低温治疗组病人脑氧耗明显好转 ,伤后早期高颅压 (ICP)、高血糖情况分别显著下降 ,生命体征及电解质等无明显差异 ,无严重并发症 ,死残率明显降低 ,预后显著改善。结论 亚低温具有显著的脑保护作用 ,临床应用于重型颅脑损伤的救治安全有效 。

Objective To study the clinical effect and the protective effect of mild hypothermia brain in patients with severe head injury.?Methods One hundred and twelve patients with severe head injury (GCS≤8)were randomly divided into mild hypothermia group(65 cases) the control group(47 cases). Hypothermia was induced within 4 12 hours after injury. The detecting head of brain temperature was put into the subdural space during the operation. The brain temperature was kept at 32～35°C,the treatment maintained for 4～7 days. Meantime,blood gas analysis of carotid artery and cervical vein,blood electrolytes,intracranial pressure(ICP),blood sugar and vital sign were measured. According to Glasgow Outcome Scale(GOS),the prognosis of the patients was evaluated.?Results In comparison with control group,during mild hypothermia the brain oxygen consumption,ICP,hyperglycemia significantly decreased,the vital sign and blood electrolytes did not significantly change. No severe complication was found. Mortality was reduced and good recovery rate was obtained in hypothermia group.?Conclusion Mild Hypothermia is safe and effective for preventing brain damage of the patients with severe head injury,No severe complication was found.