从脑氧代谢角度探讨亚低温治疗重型颅脑损伤的近期疗效

Effect of mild hypothermia on severe head injuries through monitoring brain tissue PO_2

目的 :对重型颅脑损伤患者在亚低温治疗过程中的脑组织氧分压 (Braintissueoxygenpressure -PbrO2 )变化进行监测、分析 ,探讨亚低温治疗重型颅脑损伤的近期疗效。方法 :重型脑外伤患者 4 2例 ,分为亚低温组、对照组。亚低温组于伤后 12h内行亚低温治疗 ( 32～ 34℃ ) ,时程 3～ 5天 ;对照组予以常规治疗。两组均持续监测PbrO2 ,并对不同时段PbrO2 行统计学分析。结果 :亚低温组和对照组重型颅脑损伤 (GCS6～ 8分 )患者于降温前、降温 4h时段及复温后的PbrO2 无显著差异 (P >0 .0 5 ) ,但亚低温组在降温 2 4、4 8、72h时段PbrO2 均低于对照组 (P <0 .0 5 )。亚低温组与对照组特重型颅脑损伤 (GCS3～ 5分 )患者各时段PbrO2 无显著差异 (P >0 .0 5 )。亚低温组中重型颅脑损伤患者的死亡率低于对照组 (P <0 .0 5 ) ,而特重型颅脑损伤患者的死亡率与对照组相比无显著差异 (P >0 .0 5 )。结论 :亚低温治疗重型颅脑损伤 (GCS6～ 8分 )能降低患者的死亡率 ,同时也降低了PbrO2 ;对特重型颅脑损伤 (GCS3～ 5分 )无明显治疗作用。

Objective:To further study the clime value of mild hypothermia for severe head injury through monitoring and analyzing the changes of brain tissue PO 2 (P br O 2) in patients with severe head injury.Methods:42 patients with severe head injury were selected for this study.Mild hypothermia group received cooling 32～34℃, for 3～5 days within 12 hours after head injury.Control group received ordinary treatment.P br O 2 in all patients were continuously monitored.Results:There was no difference in P br O 2 between severe head injury patients in both groups (GCS 6～8) before cooling,4 hours after cooling or after rewarming( P >0.05 );P br O 2 was lower in cooling group than that in control group at 24 hours/48 hours/72 hours after cooling ( P <0.05 ).There was no difference between patients with GCS 3～5 in both groups at different periods ( P >0.05).The mortality rate of patients with severe head injury (GCS 6～8) in mild hypothermia group is obviously lower than that in control group ( P <0.05).There was no difference in mortality rate between patients with GCS 3～5 in two groups.Conclusion:The mortality rate of severe head injury (GCS 6～8) patients decreased through mild hypothermia therapy, but P br O 2 of the severe head injury (GCS 6～8) patients treated with mild hypothermia decreased at the same time.To patients with GCS 3～5,mild hypothermia therapy is ineffective.