选择亚低温治疗时限对于急性重度颅脑损伤的临床研究

The clinical study of choosing time limit of mild hypothermia on patients with severe head injury

目的:研究应用亚低温治疗对重度颅脑损伤病人的影响,并检测其脑脊液中氨基酸含量,希望为临床上监测和治疗重度颅脑损伤提供可靠的途径。方法:重型颅脑损伤病人60例,在入院后随机分成三组,每组为20例,分别在伤后2h,6h,12h内进行亚低温治疗。直肠温度控制在31.5～33.9℃,持续1～7d,平均(57.7±25.3)h。持续监测脑脊液中氨基酸含量1～5d,平均(53.8±24.2)h,在伤后3个月对病人进行随访,根据GOS估计法来判断预后。结果:60例病人中,于伤后2h应用亚低温治疗组,3个月时,该组病人良好率为80％,6h应用亚低温治疗组,3个月时,该组病人良好率为50％,而12h开始应用亚低温治疗,病人的恢复情况与不应用该治疗方法相差无几,均为40％。这与脑脊液中氨基酸含量变化趋势相一致。结论:在重度颅脑损伤急性期,应尽早应用亚低温治疗,测定脑脊液中氨基酸含量,是个安全可靠的方法。该方法会成为一种重要手段。

Objective: To study the changes of patients with severe head injury, who received mild hypothermia. Ammonia in CSF of patients was also monitored in an attempt to develop a new path to monitor and treat severe head injury. Methods: 60 cases of severe head injury were divided into three groups. They were differently treated with mild hypothermia 2 , 6 and 12 hours after injured respectively. Rewarming was begun 1-7 days (average 57. 7±25. 3 hours) after the rectal temperature (RT) reached 31. 5- 33. 9℃. Monitoring of ammonia in CSF lasted for 1-5 days (average 53. 8±24. 2 hours). According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated. Results: The patients who received mild hypothermia 2 hours after injured showed 80% improvement rate in this group 3 months after they were followed up . The group who received mild hypothermia 6 hours after injury showed 50% improvement rate. The group who received this treatment 12 hours after that was 40%, Which showed no significant difference with the patients who did not received the mild hypothermia. Conclusions: This study indicates that the mild hypothermia should be taken in action on the patients with severe head injury as soon as possible. Monitoring ammonia in CSF is a safe, reliable diagnostic method. It might be an important tool in judging condition and guiding right treatment.