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.     

Can we further optimize therapeutic hypothermia for hypoxic-ischemic encephalopathy?

Perinatal hypoxic-ischemic encephalopathy is a leading cause of neonatal death and disability.Therapeutic hypothermia significantly reduces death and major disability associated with hypoxic-ischemic encephalopathy;however,many infants still experience lifelong disabilities to movement,sensation and cognition.Clinical guidelines,based on strong clinical and preclinical evidence,recommend therapeutic hypothermia should be started within 6 hours of birth and continued for a period of 72 hours,with a target brain temperature of 33.5 ±0.5℃ for infants with moderate to severe hypoxic-ischemic encephalopathy.The clinical guidelines also recommend that infants be re warmed at a rate of 0.5℃ per hour,but this is not based on strong evidence.There are no randomized controlled trials investigating the optimal rate of rewarming after therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy.Preclinical studies of rewarming are conflicting and results were confounded by treatment with sub-optimal durations of hypothermia.In this review,we evaluate the evidence for the optimal start time,duration and depth of hypothermia,and whether the rate of rewarming after treatment affects brain injury and neurological outcomes.     

重型颅脑创伤病人CSF中IL-6含量的变化及其临床意义

目的研究急性重型颅脑创伤(sTBI)病人脑脊液(CSF)中白细胞介素-6(IL-6)含量的变化及亚低温治疗对其影响与临床意义。方法80例急性sTBI患者(伤后6h内入院,GCS≤8分)随机分为亚低温(HT)组和常温(NT)组各40例,采用放射免疫法检测亚低温治疗前(伤后早期)、后不同时段CSF中IL-6的含量,同时对比两组病人的颅内压(ICP)、GlasgowOutcomeScale(GOS)计分指标并分析其间关系。结果急性sTBI病人伤后早期CSF中IL-6含量明显增高。与NT组病人比较,亚低温治疗后24h,HT组病人的ICP值和IL-6含量明显降低(P<0.05;P<0.05),并持续至复温后24h(P<0.01;P<0.01),而IL-6含量在伤后1个月时仍明显低于NT组(P<0.01)。HT组病人伤后6个月时的GOS计分明显高于NT组(P<0.05),即HT组病人的预后较好。结论sTBI病人急性期CSF中IL-6含量增高,亚低温可降低急性sTBI后的高ICP和明显抑制IL-6超表达,改善临床预后。     

亚低温治疗重型颅脑损伤的效果观察

目的观察亚低温对重型颅脑损伤（sTBI）患者的治疗效果。方法36例sTBI患者（Gcs≤8分）随机分为对照组和亚低温组,每组18例。伤后0、1、3、7、14、21d各行一次头颅CT检查,手术后病人均持续监测颅内压7d。对照组维持正常体温,亚低温组人院后在4．8h内将肛温降至33℃左右,并维持3～5d。比较两组颅内压、伤灶脑水肿体积变化和预后不良（GOS〈3分）率。结果在伤后第7天,对照组和亚低温组颅内压分别为（3．15±0．24）kPa和（1．78±0．24）kPa;在伤后第14天,对照组和亚低温组伤灶脑水肿体积分别为（140．90±22．95）cm^3和（81．72±15．95）cm^3;伤后1周内患者清醒率对照组和亚低温组分别为22．2％（4／18）和55．6％（10／18）;伤后3年随防时,预后不良率对照组为55．6％（10／18）,亚低温组为22．2％（4／18）。上述指标两组比较均相差显著（P〈0．05）。结论亚低温治疗法能减轻颅脑损伤患者的脑水肿,稳定其颅内压、缩短其昏迷时间,从而改善其远期预后。     

血管内降温治疗重型颅脑创伤安全性及有效性的研究

目的 对血管内降温治疗急性重型颅脑创伤患者的安全性及有效性进行前瞻性的研究.方法 共30例患者,均于伤后12 h内行血管内降温治疗,体内温度控制在33℃～35℃,持续4-7 d,平均(121.5±13.7)h.患者均于伤后6个月时根据COS评估法判定疗效.结果 经6个月随访,良好11例,中残5例,重残6例,植物生存6例,死亡2例.本组患者没有出现与血管内降温系统相关的严重并发症.结论 血管内降温具有降温速度快、目标温度维持稳定、波动性小以及复温速度容易控制等优点.对于重型颅脑创伤的患者是一种安全、有效的治疗方法.     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

Therapeutic Hypothermia for Traumatic Brain Injury

Experimental evidence demonstrates that therapeutic temperature modulation with the use of mild induced hypothermia (MIH, defined as the maintenance of body temperature at 32-35?°C) exerts significant neuroprotection and attenuates secondary cerebral insults after traumatic brain injury (TBI). In adult TBI patients, MIH has been used during the acute "early" phase as prophylactic neuroprotectant and in the sub-acute "late" phase to control brain edema. When used to control brain edema, MIH is effective in reducing elevated intracranial pressure (ICP), and is a valid therapy of refractory intracranial hypertension in TBI patients. Based on the available evidence, we recommend: applying standardized algorithms for the management of induced cooling; paying attention to limit potential side effects (shivering, infections, electrolyte disorders, arrhythmias, reduced cardiac output); and using controlled, slow (0.1-0.2?°C/h) rewarming, to avoid rebound ICP. The optimal temperature target should be titrated to maintain ICP <20?mmHg and to avoid temperatures <35?°C. The duration of cooling should be individualized until the resolution of brain edema, and may be longer than 48?h. Patients with refractory elevated ICP following focal TBI (e.g. hemorrhagic contusions) may respond better to MIH than those with diffuse injury. Randomized controlled trials are underway to evaluate the impact of MIH on neurological outcome in adult TBI patients with elevated ICP. The use of MIH as prophylactic neuroprotectant in the early phase of adult TBI is not supported by clinical evidence and is not recommended.     

亚低温治疗重型外伤性颅脑损伤的临床对照观察

目的 比较亚低温治疗和常温治疗重型外伤性颅脑损伤的治疗效果,方法 50例重型颅脑损伤患者随机分为常温组26例和亚低温组24例.入院后病人均持续监测颅内压7 d.对照组维持正常体温,亚低温组入院后在3～7 h内将肛温降至33℃左右,并维持3～7 d.比较2组GCS评分、颅内压、临床预后指标.结果 在伤后第7天,亚低温组和...     

体温控制对重型颅脑损伤血肿清除术后的疗效及血清IMA、MDA的影响

目的 探讨体温控制对重型颅脑损伤（sTBI）血肿清除术后的疗效及血清缺血修饰蛋白（IMA）、丙二醛（MDA）的影响。方法 2012年3月到2013年1月收治符合标准的sTBI 45例,均行开颅血肿清除术;术后根据体温控制水平分为观察组（25例）和对照组（20例）。观察组使用亚低温治疗仪联合冬眠药物将肛温控制在36.0~36.4 ℃,维持7 d后自然复温;对照组采用传统降温措施将肛温控制在36.5~37.7 ℃。采用ELISA法检测血清IMA、MDA水平。结果 观察组颅内压在治疗后3 d开始逐渐下降,7 d明显低于对照组（PP<0.05）。两组并发症发生率无统计学差异（>P>0.05）。两组血清IMA及MDA水平均在治疗前最高,治疗后1~7 d逐渐下降,治疗组较对照组下降更明显（P<0.05）。>结论 肛温控制在36.0~36.4 ℃对sTBI颅内血肿清除术后患者有脑保护作用,其机制可能与降低血清IMA 及MDA水平,减轻缺血再灌注损伤有关。     

Thermoregulatory vasococonstriction and shivering impede therapeutic hypothermia in acute ischemic stroke patients.

Objectives. We tested the hypothesis that vasoconstriction and shivering thresholds are sufficiently reduced by acute stroke to permit induction of therapeutic hypothermia without additional pharmacological inhibition of thermoregulatory control. Methods. We studied eight patients 2 +/- 1 days after ischemic stroke. Forced-air cutaneous cooling was administered until the patients shivered continuously or reached a tympanic membrane (ie, core) temperature of 34 degrees C. The tympanic membrane temperatures triggering vasoconstriction and shivering identified the thresholds for each response. Results. Patients had a mean age of 68 +/- 8 years and a mean National Institutes of Health Stroke Scale (NIHSS) score of 5. No patient reached the target core temperature of 34 degrees C. Vasoconstriction and shivering thresholds were 37.1 +/- 0.4 degrees C and 36.6 +/- 0.4 degrees C, respectively. Conclusions. Vasoconstriction and shivering were initiated at roughly normal temperatures in ischemic stroke patients, and these thermoregulatory responses prevented induction of therapeutic hypothermia. Pharmacological reduction of the vasoconstriction and shivering thresholds will be required if therapeutic hypothermia for stroke patients is to be induced easily by surface cooling.     

有创颅内压监测靶向管控在重型颅脑损伤患者围术期应用价值分析

目的探讨有创颅内压（ICP）监测靶向管控在重型颅脑损伤（sTBI）患者围术期的应用价值。 方法选取千佛山医院神经外科诊疗中心自2017年1月至2021年12月收治住院的168例sTBI患者的临床资料进行回顾性队列研究，将应用ICP监测的sTBI患者设为试验组（88例），同期未应用ICP监测的sTBI患者为对照组（80例）。对2组患者甘露醇的应用情况、术后并发症、出院时GOS评分、住院费用、住院时间及神经外科重症监护病房（NSICU）治疗时长进行对比分析。 结果相较于对照组，试验组患者甘露醇的使用时长及总量均显著降低，住院及NSICU治疗时长显著减少，而预后良好率更高，差异均具有统计学意义（P<0.05）；2组患者的颅内感染率和非计划再次手术率比较，差异无统计学意义（P>0.05）。 结论有创ICP监测下的靶向管控对于sTBI患者可以动态监测患者ICP变化，及时评估病情，更有效地控制甘露醇的使用，显著降低住院时长，提高患者预后，降低颅内感染率。     

ICU重型颅脑损伤患者行血管内控制性降温治疗的疗效分析

目的探讨血管内降温治疗对重型颅脑损伤患者意识水平、脑氧代谢和颅内压（ICP）的影响。 方法选取2015年4月至2017年4月郑州大学附属郑州中心医院重症医学科收治的重型颅脑损伤术后患者100例,按照随机数字表法分为对照组和观察组,每组50例。对照组给予常规标准化治疗,观察组给予血管内降温治疗。观察并比较2组患者治疗前、治疗3 d后意识水平、ICP、脑氧代谢变化。 结果2组患者治疗后的意识水平、ICP、脑氧代谢等指标水平均较同组治疗前均显著提高,差异有统计学意义（P<0.05）,且治疗后观察组水平均显著高于对照组,差异有统计学意义（P<0.05）。 结论血管内降温治疗能明显改善重型颅脑损伤患者的意识水平,提高脑氧代谢水平,同时降低ICP,具有重要的临床实践价值。