血液滤过亚低温治疗急性脑卒中新方法探讨

Hypothermia hemofiltration in treatment of acute cerebral stroke

目的 寻找一种快速的亚低温降温方法 ,为治疗急性脑卒中辟出新路。方法 76例急性脑卒中患者随机分为两组 ,亚低温血液滤过治疗组 (A组 ) 38例及常规亚低温治疗组 (B组 ) 38例 ,观察两组患者直肠温度降至 33℃的降温速率、降温时间、治疗前后格拉斯哥昏迷分级评分 (Glasgowcomascale,GCS)及神经功能缺损评分。 结果 A组降温速率较B组高 (P <0 .0 0 1) ,降温时间较B组短 (P <0 .0 0 1) ,治疗 15天及治疗 30天A组明显改善GCS评分 (P <0 .0 5～ 0 .0 1)、明显减低神经功能缺损评分 (P <0 .0 5～ 0 .0 0 1)。结论 血液滤过亚低温治疗急性脑卒中可明显缩短降温时间 ,相对延长亚低温治疗时间窗 ,扩大亚低温脑保护的治疗范围 ,充分保护脑组织 。

Objective To find a quicker and better means of hypothermia for better treatment effect.Methods 76 patients with acute cerebral stroke were randomly allocated to two groups,in group A(n=38)routine hypothermia with arteriovenous hemofiltration was applied,in group B (n=38) only routine hypothermia was given.The different lengths of time needed for hypothermia to 33℃ in the rectum were observed and their Glasgow coma scale (GCS) and neurologic deficit scores compared.Results In group A hypothermia took significantly less time than that in group B (P< ] 0.001 ).The average time taken for hypothermia in Group A was 57.1 minutes less than that taken in group B.Moreover,GCS scores in Group A were significantly higher than in Group B (P< 0.05 - 0.01 ),while neurologic deficit scores were significantly lower than in Group B ( P < 0.05 - 0.001 ).Conclusion Hemofiltration can definitely shorten the time to reach the target temperature in moderate hypothermia therapy,raising the effect of treatment of moderate hypothermia and improving the prognosis.