亚低温治疗急性重型颅脑损伤的临床观察

Clinical observation of mild hypothermia treatment in patients with severe head injury

目的 观察亚低温治疗急性重型颅脑损伤的疗效 ;探讨亚低温治疗的平稳性和安全性。方法将 1 1 2例急性重型颅脑损伤随机分为亚低温组 (5 5例 )和对照组 (5 7例 )。亚低温组入院后或术后立即给予亚低温治疗 ,酌情运用冬眠合剂、肌松剂和呼吸机 ,肛温控制在 32℃～ 34℃ ,持续 2 4小时～ 5天。对照组给予常规治疗。两组均观察颅内压 (ICP)、生命体征、脑干听觉诱发电位 (BAEP)Ⅰ /Ⅴ波幅比值等的变化。结果 亚低温组经亚低温治疗后 ,ICP下降明显 ;1 1例血压下降 ,1 2例心率减慢 ,复温后 ,以上指标均恢复正常 ;亚低温治疗后 2 4小时及复温后 ,双侧BAEPⅠ /Ⅴ比值与对照组同时段相比差异显著。亚低温组死亡 1 3例 ,死亡率 2 3.6 % ;对照组死亡 2 6例 ,死亡率 4 5 .6 % ,两组有显著性差异。结论 亚低温治疗能降低脑外伤后增高的ICP ,从而使死亡率及致残率明显下降。亚低温治疗中合理使用辅助药物 。

Objective To study the clinical effects and safety of mild hypothermia treatment in patients with severe head injury.Methods One hundred and twelve patients with severe head injury were randomly divided into mild hypothermia group(55 cases) and control group(57 cases). Patients in the hypothermia group were treated by mild hypothermia,keeping anal temperature at 32℃ 34℃ for 24 hours for 5 days,at the same time lytic cocktail,paramyon,respiratory aid were given if necessary. The patients of control group were given routine treatment. The level of intracranial pressure(ICP),vital signs and brainstem auditory evoked potential(BAEP Ⅰ/Ⅴ) of the both groups were measured.Results The level of ICP reduced significantly after mild hypothermia treatment in the first group,blood pressure lowered in 11 cases,and heart rate reduced in 12 cases.All of the parameters were normal after the temperature returned to normal level. Thirteen cases died in the first group(23.6%),while 26 cases died in the control group(45.6%),showing great difference between these two groups.Conclusion The high level of ICP caused by severe head injury could be reduced after mild hypothermia treatment,thus reducing the mortality rate.Supplementary medicine used in properly could ensure the safety of the treatment.