亚低温对重型颅脑损伤术后脑血管痉挛的影响

目的探讨亚低温对重型颅脑损伤（severe traumatic brain injury,sTBI）术后脑血管痉挛（cerebral vasospasm,CVS）及远期预后的影响。方法36例sTBI患者（GCS≤8分）,随机分为对照组和亚低温组,各18例。用脑循环动力检测仪检测伤后0、1、3、7、10、14、21 d的脑循环动力学参数（CV-DI）。对照组维持正常体温,亚低温组在4-8 h内将肛温降至33℃左右,维持3-5d。分析比较两组CVDI变化规律和远期预后。同期筛选出24例正常人检测其CVDI,作为正常组。结果①与正常组比较,对照组伤后CVDI可划分为4个期,即低灌注期（0 d）、高灌注期（1-3 d）、CVS期（4-14 d）、好转期（〉15 d）;而亚低温组仅表现出三个期,即低灌注期（0 d）、好转期（1-3 d）、恢复期（〉4 d）,未出现高灌注期和CVS期。②随防3个月时,对照组预后不良率为61.1%（11/18）,亚低温组为33.3%（6/18）,两组比较无显著性差异（P〉0.05）;随防3年后,对照组预后不良率为55.6%（10/18）,亚低温组为22.2%（4/18）,两组比较差异显著（P〈0.05）。结论sTBI术后要注重CVS的防治。亚低温能稳定sTBI术后脑循环功能,减少CVS发生率,从而改善远期预后。

Effect of the Mild Hypothermia on the Cerebral Vasospasm after Severe Traumatic Brain Injury Operation

Objective To investigate the effect of mild hypothermia on cerebral vasospasm after severe traumatic brain injury （sTBI） operation and its future prognosis. Methods Thirty-six patients with sTBI（ GCS≤8 ） were randomly divided into the conventional therapy group （control group） and the mild hypothermia group with 18 patients in each. The cerebrovaseular hemodynamie indices（CVDI） were measured 0, 1 , 3, 7, 10, 14, 21 days after sTBI with the cerebrovascular hemodynamics analyzer. Results Compared with normal group, posttraumatic CVDI in the control group was divided into 4 phases： hypoperfusion（ Day 0）, hyperperfusion （Days 1 - 3）, cerebral vasospasm （CVS） （ Days 4 - 14）, intermediary （ 〉 15 days）. There were three phases in the mild hypothermia therapeutic group ： hypoperfusion （ Day 0）, intermediary （ Days 1 - 3 ）, recovery （ 〉 4 days）. There were 8 cases and 2 cases of CVS in the control and the therapy group respectively（P 〈 0.05）. At 3 months follow- up,the rates of unfavorable prognosis were 61.1% （11/18） in control group and 33.3% （6/18） in the mild hypothermia group （P 〉0.05）. After 3 years follow-up,the rates of unfavorable prognosis were 55.6% （10/18） in control group and 22.2% （4/18） in the mild hypothermia group （P 〈 0.05）. Conclusions Preventing and curing of CVS is important after sTBI operation. Mild hypothermia treatment can reduce the incidence of CVS by stabilizing cerebral circulation after sTBI, so that the future prognosis can be improved.