重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

亚低温对重型颅脑创伤患者血清抗脑抗体含量的影响

目的 研究重型颅脑创伤(sTBI)后患者血清抗脑抗体(ABAb)浓度变化及亚低温治疗对血清ABAb浓度的影响,探讨亚低温脑保护机制.方法 选择80例sTBI住院患者,随机分成常温治疗(NT)组和亚低温治疗(HT)组各40例,分别予以常温治疗和亚低温治疗,于伤后第1、3、5、7、14天采血.用酶联免疫吸附(ELISA)法测定血清ABAb浓度,观察各时间点血清ABAb浓度的变化,分析各时间点两组血清ABAb浓度与格拉斯哥预后评分(GOS)的相关性.另取20例健康体检者作为对照组.结果 (1)所有sTBI患者在伤后各时间点血清ABAb浓度高于正常对照组(P＜0.01).(2)HT组于伤后各时间点血清ABAb浓度低于NT组,且差异有统计学意义(P＜0.01).(3)NT组于伤后各时间点血清ABAb浓度与GOS评分呈负相关,出院时HT组预后也较NT组为佳.结论 HT能够降低sTBI患者血清ABAb含量,具有脑保护作用,其脑保护机制可能与HT能减轻血清ABAb介导的损伤性脑细胞炎性反应有关.

Abstract：

Objective To disclose the Probably protective mechanism of mild hypothermia protecting brain through investigating the contents charges of Antibrain-Antibody(ABAb)in serum in patients with severe traumatic brain injury(sTBI) and the influence of mild hypothermia on serum levels of ABAb.Methods A total of 80 cases with sTBI were treated with normothennia - treated (NT) (NT group, re =40)and mild hypothermia( HT) (HT group, n =40) respectively. ELISA was used to measure serum levels of ABAb. Groups at 1、3、5、7 and 14 days after injury to observe the contents changes of ABAb in serum and the influence of mild hypothermia. Simultaneous analysis two groups at each time point of serum ABAb concentration and Glasgow outcome scale (GOS) of relevance was performed Contrast analysis of clinical prognosis for patients in the two groups was carried out to reveal the protective mechanism of mild hypothermia protecting on patients with sTBL 20 serum specimens of normal persons were used as control group. Results (1) All sTBI patients at each time point after injury, serum ABAb levels were higher than the normal control group ( P ＜0.01). (2) Concentration of antibodies in the serum ABAb levels in HT group at each time point was lower than in NT group( P＜0.01). (3) Concentration of serum ABAb levels in NT group at each time point of injury was negatively correlated with the GOS score; prognosis at discharge in HT group was better than in NT group. Conclusions HT can reduce the serum ABAb levels in sTBI patients, improve the prognosis, have brain protective effect The brain protective mechanisms may be related to the mild hypothermia which reduce the serum ABAb - mediated inflammatory damage on brain cells.     

亚低温对大鼠弥漫性脑损伤后海马CA1区Apaf-1蛋白表达和学习记忆功能的影响

目的 探讨亚低温对大鼠弥漫性脑损伤(DBI)后海马CA1区Apaf-1蛋白表达及大鼠学习记忆功能的影响.方法 选择雄性Wistar大鼠48只,按照完全随机数字表法分为正常组、假手术组、脑损伤组和亚低温组,每组12只.正常组不做任何处理;假手术组仅给予麻醉及头皮切开、缝合,但不致伤;脑损伤组和亚低温组根据Marmarou方法制作DBI模型,亚低温组大鼠损伤后用冰毯及冰袋物理降温,使大鼠肛温在15 min内控制至30.0～31.0℃,维持2 h.14 d后比较各组大鼠Morris水迷宫实验成绩,同时比较各组大鼠海马CA1区Apaf-1蛋白的表达.结果 正常组、假手术组、脑损伤组和亚低温组大鼠搜索安全岛的次数分别为(10.1±1.9)次、(10.3±1.8)次、(3.8±2.3)次和(6.9±1.1)次,差异有统计学意义(P<0.05).脑损伤组及亚低温组海马CA1区Apaf-1蛋白含量高于正常组及假手术组,其中脑损伤组Apaf-1蛋白含量明显高于亚低温组,差异均有统计学意义(P<0.05).结论 亚低温可能通过抑制神经细胞凋亡对脑组织产生保护作用,从而改善大鼠脑损伤后学习记忆障碍.

Abstract：

Objective To investigate the influence of mild hypothermia on the apoptotic protease activating factor-1 (Apaf-1) protein expression in the hippocampal CA1 area and learning and memory functions of rats after diffuse brain injury (DBI). Methods Forty-eight male Wistar rats were equally randomized into normal group, sham-operated group, brain injury group and mild hypothermia treatment group (n=12). Rats in the normal group did not receive any treatment; rats in the sham-operated group only received anesthesia, and incision and suture of scalp; rats in the brain injury group and mild hypothermia treatment group were induced the DBI models according to Marmarou method; and rats in the mild hypothermia treatment group were performed hypothermia with ice blanket and ice bag to control the rectal temperature within 30.0-31.0 ℃ for 2 h. After DBI for 2 weeks, the times of searching refuge platform and the protein expression of Apaf-1 were compared among the 4 groups. Results The times of searching refuge platform in the normal group, sham operated group, brain injury group and mild hypothermia treatment group were (10.1 ±1.9), (10.3±1.8), (3.8±2.3) and (6.9±1.1), respectively,with significant differences between each 2 groups (P<0.05). The protein expression of Apaf-1 in the brain injury group and mild hypothermia treatment group was obviously higher than that in the other groups (P<0.05), and significantly lower protein expression of Apaf-1 in the mild hypothermia rats was noted as compared with that in the brain injury rats (P<0.05). Conclusion Mild hypothermia might play a protective role by inhibiting neuronal apoptosis for rats with DBI through the Apaf-1 pathway,which can improve learning and memory abilities.     

不同时间局部亚低温治疗弥漫性轴索损伤的预后分析

目的 探讨弥漫性轴索损伤(DAD后不同时间点行亚低温治疗与患者预后的关系.方法 回顾性分析桂林市全州县人民医院院神经外科自2006年1月至2010年1月收治的48例弥漫性轴索损伤患者的临床资料,按照伤后有无在常规治疗的基础上加用局部亚低温辅助治疗分为亚低温治疗组(n=23)和对照组(n=25),前者按治疗时间又分为伤后8h内亚低温治疗组(n=9)和伤后8 h后亚低温治疗组(n=14),治疗6个月后对患者行GOS评定,分析患者的预后.结果 3组患者年龄、性别比例、治疗前颅内压、GCS评分方面差异均无统计学意义(P>0.05);分别接受不同治疗后3组患者预后差异有统计学意义(x2-6.671,P=0.036),由平均秩次判断,预后最好的为伤后8 h内亚低温治疗组,其次为伤后8 h后亚低温治疗组和对照组.结论 弥漫性轴索损伤患者伤后早期(8 h内)进行局部亚低温辅助治疗有助于脑功能的恢复,提高预后.     

不同时间局部亚低温治疗弥漫性轴索损伤的预后分析

目的 探讨弥漫性轴索损伤(DAD后不同时间点行亚低温治疗与患者预后的关系.方法 回顾性分析桂林市全州县人民医院院神经外科自2006年1月至2010年1月收治的48例弥漫性轴索损伤患者的临床资料,按照伤后有无在常规治疗的基础上加用局部亚低温辅助治疗分为亚低温治疗组(n=23)和对照组(n=25),前者按治疗时间又分为伤后8h内亚低温治疗组(n=9)和伤后8 h后亚低温治疗组(n=14),治疗6个月后对患者行GOS评定,分析患者的预后.结果 3组患者年龄、性别比例、治疗前颅内压、GCS评分方面差异均无统计学意义(P>0.05);分别接受不同治疗后3组患者预后差异有统计学意义(x2-6.671,P=0.036),由平均秩次判断,预后最好的为伤后8 h内亚低温治疗组,其次为伤后8 h后亚低温治疗组和对照组.结论 弥漫性轴索损伤患者伤后早期(8 h内)进行局部亚低温辅助治疗有助于脑功能的恢复,提高预后.     

亚低温治疗重型颅脑损伤患者的血清S-100B蛋白含量分析

目的 通过检测亚低温治疗后重型颅脑损伤患者血清S-100B蛋白含量的变化来证实亚低温治疗的脑保护作用,探讨其可能的作用机制.方法 选取100例正常体检者为对照组,选取100例重型颅脑损伤患者(GCS≤8分1并分为亚低温治疗组50例和常温治疗组50例,分别于伤后早期(2～6 h)及伤后不同时间(1 d、3 d、5 d、7 d、10 d)采血,检测血清中S-100B蛋白含量,比较其在伤后不同时期的血清S-100B蛋白含量.结果 正常体检者血清S-100B蛋白含量测定结果证实,正常人血清S-100B蛋白含量与年龄、性别无关.亚低温治疗组、常温治疗组患者伤后血清S-100B蛋白含量与对照组相比差异有统计学意义(P<0.01).伤后1 d、3 d、5 d、7 d、10 d时亚低温治疗组血清S-100B含量明显低于常温治疗组,差异有统计学意义(P(0.05).结论 血清S-100B蛋白在重型颅脑损伤的诊断巾有高度敏感性和特异性,是一种有效的生化指标.亚低温治疗对重型颅脑损伤具有脑保护作用.     

Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury.

To compare the effect of long-term mild hypothermia versus short-term mild hypothermia on the outcome of 215 severe traumatic brain injured patients with cerebral contusion and intracranial hypertension. At three medical centers, 215 patients aged 18 to 45 years old with an admission Glasgow Coma Scale < or =8 within 4 h after injury were randomly divided into two groups: long-term mild hypothermia group (n = 108) for 5+/-1.3 days mild hypothermia therapy and short-term mild hypothermia group (n = 107) for 2+/-0.6 days mild hypothermia therapy. All patients had intracranial hypertension and frontotemporoparietal contusion with midline shift >1 cm confirmed on computed tomographic scan. Glasgow Outcome Scale at 6-month follow-up, 47 cases had favorable outcome (43.5%), and other 61 cases had unfavorable outcome (56.5%) in the long-term mild hypothermia group. However, only 31 cases had favorable outcome (29.0%), and other 76 cases had unfavorable outcome (71.0%) in the short-term mild hypothermia group (P < 0.05). The intracranial pressure significantly rebounded after rewarming in the short-term mild hypothermia group, but not in the long-term mild hypothermia (P < 0.05). Furthermore, the incidence of stress ulcer, epilepsy, pulmonary infection, intracranial infection did not significantly differ between the two groups (P > 0.05). Compared with short-term mild hypothermia, long-term mild hypothermia significantly improves the outcome of severe traumatic brain injured patients with cerebral contusion and intracranial hypertension without significant complications. Our data suggest that 5 days of long-term cooling is more efficacious than 2 days of short-term cooling when mild hypothermia is used to control refractory intracranial hypertension in patients with severe traumatic brain injury.     

亚低温治疗对重型颅脑损伤患者血浆内皮素的影响

目的探讨亚低温治疗重型颅脑损伤的临床疗效及其对血浆内皮素(ET)分泌的调控作用。 方法选取50例重型颅脑损伤患者,分为观察组(n=25)和对照组(n=25)。对照组给予常规治疗,观察组给予常规治疗联合亚低温治疗。比较两组血浆ET表达、颅内压(ICP)及临床预后。 结果治疗后第1~5天,观察组患者血浆ET均显著低于对照组,组间比较差异显著(P<0.05)。治疗后第1~5天,观察组患者ICP均显著低于对照组,组间比较差异显著(P<0.05)。观察组中预后良好7例、轻残8例、重残6例、植物生存2例、死亡2例;对照组预后良好3例、轻残4例、重残10例、植物生存3例、死亡5例,观察组预后情况明显优于对照组,组间比较差异显著(P<0.05)。 结论亚低温治疗的脑保护作用可能与抑制ET分泌,降低ICP有关。     

重型颅脑损伤患者亚低温治疗的临床研究

目的 通过比较重型颅脑损伤患者亚低温治疗组与常温治疗组的预后来证实亚低温治疗的脑保护作用. 方法 选取重型颅脑损伤患者76例(GCS≤8分),分为亚低温治疗组(36例)和常温治疗组(40例).常温治疗组患者应用脱水降颅压、营养神经、止血、抑制胃酸分泌、营养支持等常规治疗.亚低温治疗组患者除常规治疗外,合并应用冰毯实行亚低温治疗(患者躺在冰毯垫上,通过体表散热使中心体温和脑温降至所需温度,通常为32～34℃,并根据病情需要维持3～14 d).结果亚低温治疗组患者预后优于常温组,差异有统计学意义(P<0.05). 结论 亚低温治疗对重型颅脑损伤患者具有脑保护作用,能提高临床疗效,值得推广应用.     

局部亚低温对颅脑损伤患者去骨瓣减压术后脑膨出并发症的影响

目的 探讨局部亚低温对颅脑损伤患者去骨瓣减压术后脑膨出并发症的控制作用.方法 选取行去骨瓣减压术治疗的重型颅脑损伤患者86例,术后给予常规治疗32例,在常规治疗的基础上加用局部亚低温辅助治疗54例.术后12 h亚低温治疗前对患者行格拉斯哥昏迷评分(GCS),检测颅内压(ICP)、脑灌注压(CPP)及血氧饱和度(SaO2).术后7d判定患者脑膨出情况并再次检测ICP及CPP. 结果常规治疗组与局部亚低温治疗组在年龄、性别、受伤至手术时间分布、亚低温治疗前GCS评分、ICP、CPP及SaO2方面的差异均无统计学意义(P＞0.05).术后7 d亚低温治疗组患者脑膨出发生率、脑膨出程度及ICP均低于常规治疗组,CPP高于常规治疗组,差异均有统计学意义(P＜0.05). 结论 去骨瓣减压术后进行局部亚低温治疗有助于提高CPP、降低ICP,并且减少脑膨出的发生率和脑膨出程度,有利于脑损伤患者功能恢复.     

弥漫性轴突损伤后早期并发癫痫患者的预后研究

目的 研究弥漫性轴突损伤(DAI)早期并发外伤性癫痫患者的预后.方法 选择暨南大学第一附属医院神经外科自2000年1月至2011年6月诊治的187例DAI患者,其中早期(伤后2周内)并发外伤性癫痫(PTE)者26例,按1:3的比例选出78例未并发PTE患者作为对照,出院时采用GOS评分和Barthel指数计分评价2组患者的预后和日常生活能力(ADL).结果 并发PTE组和未并发PTE组患者预后、日常生活能力不同,差异均有统计学意义(P＜0.05),由平均秩次判断,早期并发PTE的DAI患者预后差于未并发PTE患者,且存活的患者中,并发PTE的DAI患者日常生活能力低于未并发PTE患者.结论 DAI患者早期发作癫痫可显著影响其预后,尤其是重症患者发作癫痫后预后较差,死亡率、致残率显著增加.     

弥漫性轴索损伤280例临床分析

目的 探讨弥漫性轴索损伤(DAI)患者的临床特点、治疗及预后.方法 广东省揭阳市人民医院神经外科自1999年1月至2009年12月共收治280例DDI患者,其中76例予以双侧开颅减压术治疗,204例保守治疗,回顾性分析患者的临床资料及治疗效果.结果 本组患者恢复良好122例(43.6%),轻残或遗留部分并发症86例(30.7%),重残37例(13.2%),植物性生存2例(0.7%),死亡33例(11.8%).结论 脑肿胀,一侧或双侧瞳孔散大DAI患者应及早行开颅去骨瓣减压术,昏迷时间长者及早行气管切开保持呼吸道通畅,早期脱水治疗选用20%甘露醇+速尿+白蛋白模式,辅助甲强龙冲击及亚低温治疗.

Abstract：

Objective To discuss the clinical features and pathological changes of diffuse axonal injury (DAI), and explore the treatment and prognosis of patients with DAI. Methods Two hundred and eighty patients with DAI, admitted to our hospital from January 1999 to December 2009,were enrolled in our study; bilateral decompressive craniotomy was performed in 76 patients and conservative treatment in 204 patients; the clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Good recovery was achieved in 122 patients (43.6%), mild disability in 86 (30.7%), severe disability in 37 (13.2%), persistent vegetative state in 2 (0.7%) and death in 33 (11.8%). Conclusion Decompressive craniotomy is needed as early as possible for patients with brain swelling, unilateral or bilateral mydriasis; early tracheotomy should be performed for patients in coma for a long time to maintain airway smooth; 20% mannitol plus furosemide plus albumin, together with methylprednisolone and mild hypothermia therapy, can be employed to treat patients with early dehydration.