亚低温治疗对弥漫性轴索损伤患者运动及生活能力的影响

Effects of mild hypothermia treatment on motor function and activities of daily living in patients with diffuse axonal injury

目的:探讨亚低温治疗对弥漫性轴索损伤(diffuseaxonalinjury,DAI)患者早期运动及日常生活活动能力(ADL)的影响。方法:在常规药物治疗和康复训练的基础上,实验组46例早期(伤后3～22h)加用亚低温治疗,并与同等条件下未用亚低温治疗的同类患者46例比较。于治疗前、治疗后3及7d分别测定两组血浆内皮素含量,于入院时和伤后3个月时分别采用Fugl-Meyer(FMA)评定两组患者ADL。结果:治疗3及7d后,实验组血浆内皮素为(73±8)和(55±6)ng/L,而对照组同期为(80±9)和(65±7)ng/L,实验组较对照组下降明显(P<0.01)。伤后3个月时实验组的FMA积分为(70±19)分,Barthel指数为(65±17)分,而对照组两项评分分别为(49±14),(47±13)分,两组比较差异均有非常显著性意义(P<0.01)。结论:早期应用亚低温治疗DAI,有利于DAI患者早期运动功能及ADL的康复。

AIM:To investigate the effects of mild hypothermia therapy on the early motor and ability of daily living(ADL) in the patients with diffuse axonal injury(DAI). METHODS:Based on the routine therapy and rehabilitation,46 early DAI patients(3-22 hours after injury,11.6 hours on average) in the experimental group were treated with mild hypothermia in comparison with other 46 DAI patients without mild hypothermia therapy. The contents of plasma endothelins (ET) were detected before and 3,7 days after treatment in the two groups.Fugl Meyer assessment(FMA)was performed to assess the motor function of extremities at admission and 3 months after injury,and ADL was evaluated with Barthel index(BI) for the patients in the two groups. RESULTS:The contents of plasma ET in the experimental group were(73±8) and(55±6) ng/L at 3 and 7 days after treatment,respectively,significantly lower than those in the control group[(80±9) and(65±7) ng/L,P< 0.01].Three months after treatment,the scores of FMA and the BI were 70±19 and 65±17 for the experimental group respectively,and 49±14 and 47±13 for the control group,respectively,suggesting that the improvement in the motor function and ADL associated with mild hypothermia was greatly better than that associated without routine therapy and rehabilitation only(P< 0.01). CONCLUSION:Early application of mild hypothermia in DAI patients significantly improves the motor function of extremities and ADL,which is beneficial to the recovery of motor function and living ability in the early stage of DAI.