复温速度对重症颅脑外伤亚低温神经保护的初步研究

目的探讨不同复温速度对重症颅脑外伤亚低温神经保护作用的影响。方法将39例亚低温治疗的重症颅脑外伤患者随机分为Ⅰ组(n=13,复温速度0.1℃/h)、Ⅱ组(n=13,复温速度0.2℃/h)及Ⅲ组(n=13,复温速度0.3℃/h)。治疗过程中动态监测颅内压、心率、血压、脉氧饱和度,每日测定血糖、血细胞分析、血气分析、凝血功能、肝肾功能、电解质,每日进行GCS评分,并于伤后3个月根据格拉斯哥预后分级(GOS)评定疗效。结果复温达36.5℃时及达标后24 hⅢ组颅内压监测(ICP)明显高于Ⅰ组,有统计学意义(P<0.05);复温达标后72 h GCSⅠ组、Ⅱ组均高于Ⅲ组,有统计学意义(P<0.05),Ⅰ组高于Ⅱ组,但无统计学意义;3个月时Ⅰ组、Ⅱ组GOS明显优于Ⅲ组(P<0.05),Ⅰ组与Ⅱ组间比较无明显差异;复温达36.5℃时及达标后24 hⅢ组血糖明显高于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05)。结论较慢的复温速度可改善脑灌注,减轻脑水肿,有效保护神经功能并改善预后。

Effects of the rate of rewarming during hypothermia therapy on neuroprotective in patients with severe traumatic brain injury

Objective To explore the effects of the rate of rewarming during hypothermia therapy on neuroprotective in patients with severe traumatic brain injury. Methods 39 cases of severe traumatic brain injury were randomly divided into group I （n=13, rewarming rate of 0.1℃/h）, II group （n=13, rewarming rate of 0.2℃/h） and G roup III （n=13, rewarming rate of 0.3℃/h） during hypothermia therapy. Intracranial pressure, heart rate, blood pressure, pulse oximetry were continuously monitored. Blood glucose, blood cell analysis, blood gas analysis, coagulation, liver and kidney function, electrolytes were measured daily. GCS score was assessed daily. GOS （Glasgow Outcome Classification ） was evaluated at 3 months after injury. Results ICP in group III was significantly higher than that in group I at points of rewarming to 36.5℃and 24 hours after rewarming to 36.5℃（P＆lt;0.05）. Compared with group III, GCS were improved in group I and II at 72 hours after rewarm（P＆lt;0.05）. GOS in Group I, II group were significantly better than that in group III （P＆lt;0.05） at 3 months after hypothermia therapy. However, there was no significant difference in GOS between I and II group. Blood glucose in group III was significantly higher than those in group I and II at points of rewarming to 36.5 ℃ and 24 hours after rewarming to 36.5℃（P＆lt;0.05）. Conclusions Cerebral edema and cerebral perfusion can be improved by slower rewarming rate. Also, neurological function and the prognosis improved.