选择性脑亚低温治疗重型颅脑损伤

Treatment of severe brain injury with selective mild hypothermia of brain

目的 比较选择性脑亚低温与全身亚低温治疗重型颅脑损伤的治疗效果。方法 将 6 9例重型颅脑损伤 (GCS≤ 8分 )患者分成 3组 :(1 )选择性脑亚低温组 2 3例 ,头部局部降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(2 )全身亚低温组 2 2例 ,全身降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(3)常温对照组 2 4例 ,予常规治疗。结果 选择性脑亚低温组预后良好率为 5 6 .5 % (1 3/ 2 3) ,病死率 2 1 .7% (5 / 2 3) ,与全身亚低温组相仿 [分别为 5 4 .5 % (1 2 / 2 2 )和 2 2 .7% (5 / 2 2 ) ],与对照组比较 (良好率 2 5 % ,病死率 4 5 .8% ) ,有显著差异(P <0 .0 5 )。全身组与对照组总并发症发生率比较无显著差异 (P >0 .0 5 ) ,而选择性脑亚低温组总并发症发生率明显低于全身组与对照组 (P <0 .0 1 )。结论 选择性脑亚低温对重型颅脑损伤的疗效与全身亚低温相仿 ,明显优于常温对照组 ,是目前治疗重型颅脑损伤安全而有效的方法之一。

Objective To compare effectiveness of treatment in selective brain mild hypothermia with that of whole body mild hypothermia.Methods Sixty nine patients with severe brain injury(GCS≤8) were divided into three groups randomly:(1)In the selective brain mild hypothermia group(n=23)the head was kept at lower temperature.(2)In the whole body mild hypothermia group(n=22)the whole body was kept at lower temperature. The brain temperature of the two groups was kept at 33～35℃,the mild hypothermia therapy continued for 3～5days.(3)In the normothermia group(n=24),conventional therapy were given.Results The rate of good prognosis and mortality in the selective brain mild hypothermia group were 56.5%(13/23),21.7%(5/23),respectively,nearly as the same as those [54.5%(12/22),22.7%(5/22)] in whole body mild hypothermia group,and obviously different from those (25%,45.8%) in the normothermia group(P< 0.05) . Total occurrence of complications in whole body mild hypothermia group were not obviously different from those in the control group(P>0.05),but total occurrence of complications in selective brain mild hypothermia group were highly significant to those in the control group(P<0.01).Conclusion The effectiveness of treatment in selective brain mild hypothermia was nearly as the same as that in whole body mild hypothermia,and highly significant to that in the control group of normothermia. It is one of safe and effective treatments in severe brain injury currently.