亚低温对急性重型颅脑损伤病人治疗机理及临床疗效研究

目的研究亚低温对急性重型颅脑损伤病人的治疗机理及临床效果.方法164例病人,随机分为亚低温治疗组和对照组.亚低温治疗组82例,均于伤后24小时内行亚低温治疗,直肠温度(RT)控制在32.0℃～35.0℃;脑温为32.5℃～35.0℃,持续1～7天,平均60.2±28.0小时.同时监测病人的生命体征、颅内压(ICP)、血糖、血乳酸、血气、血电解质以及脑组织氧分压(PbrO2)和脑组织温度(BT)、脑微循环血流(LDF血流值)和颈静脉血氧饱和度(SjvO2).对照组82例,直肠温度控制在36.5℃～37.0℃,其他治疗同亚低温组.两组病人均于伤后3个月时根据GOS评估法判定疗效.结果与对照组相比,亚低温治疗组病人伤后早期的高ICP、高血糖、高乳酸血症分别显著下降(P＜0.05);严重的低PbrO2迅速上升并维持在正常水平;脑血供得到改善;生命体征、血气及血电解质无显著差异;无严重并发症;死亡率降低,恢复良好率提高,预后显著改善.结论亚低温具有肯定的脑保护作用,临床上用于治疗急性重型颅脑损伤病人,安全有效,可降低死亡率,提高生存质量,无严重并发症.直接监测PbrO2、BT、LDF血流值和SjvO2,对亚低温治疗更有指导意义.     

深静脉导管联合一次性输液器治疗液气胸11例临床分析

我院自2006年6月～2007年12月利用深静脉导管与一次性输液器联合行胸腔持续引流治疗液气胸11例,取得了满意的效果.在治疗过程中,感受到深静脉导管联合一次性输液器持续引流液气胸的诸多优点,现报告如下.     

Effect of mild hypothermia on partial pressure of oxygen in brain tissue and brain temperature in patients with severe head injury

OBJECTIVE: To study the changes of partial pressure of oxygen in brain tissue (P(bt)O(2)) and brain temperature (BT) in patient s in acute phase of severe head injury, and to study the effect of mild hypothermia on P(bt)O(2) and BT. METHODS: The P(bt)O(2) and the BT of 18 patients with severe head injury were monitored, and the patients were treated with mild hypothermia within 20 hours after injury. The rectal temperature (RT) of the patients was kept on 31.5-34.9 degrees C for 1-7 days (57.7 hours+/-28.4 hours averagely), simultaneously, the indexes of P(bt)O(2) and BT were monitored for 1-5 days (with an average of 54.8 hours+/-27.0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated at 6 months after injury. RESULTS: Within 24 hours after severe head injury, the P(bt)O(2) was significantly lower (9.6 mm Hg+/-6.8 mm Hg, 1 mm Hg=0.133 kPa) than the normal value (16-40 mm Hg). After treatment of mild hypothermia, the mean P(bt)O(2) increased to 28.7 mm Hg+/-8.8 mm Hg during the first 24 hours, and the P(bt)O(2) was still maintained within the range of normal value at 3 days after injury. The BT was higher than the RT in the patients in acute phase of severe head injury, and the difference between the BT and the RT significantly increased after treatment of mild hypothermia. Hyperventilation (the partial pressure of carbon dioxide in artery (P(a)CO(2)) approximately 25 mm Hg) decreased the high intracranial pressure (ICP) and significantly decreased the P(bt)O(2). CONCLUSIONS: This study demonstrates that P(pt)O(2) and BT monitoring is a safe, reliable and sensitive diagnostic method to follow cerebral oxygenation. It might become an important tool in our treatment regime for patients in the acute phase of severe head injury requiring hypothermia and hyperventilation.     

亚低温治疗对重型脑损伤急性期脑氧分压和脑温的影响

目的研究重型脑损伤急性期脑组织氧分压(P     

颅脑损伤并发颅内感染给药途径探讨

颅脑损伤并发颅内感染严重影响病人的预后,使病死率明显增高,因此颅内感染的预防和诊治是颅脑损伤研究中的重要课题。笔者就这一问题结合本院1999年1月至2000年12月收治的18例颅脑损伤并发颅内感染病人的临床资料进行探讨。