亚低温治疗自发性脑出血的临床疗效和安全性

目的 探讨亚低温治疗自发性脑出血的疗效和安全性。方法 2015年1月至2017年3月收治急性自发性脑出血78例，按术后体温控制方法分为低温组（n=39）和常温组（n=39）。均采用急诊手术清除血肿。低温组术后采用全身物理降温，将直肠温度维持于34~35 ℃，3 d后缓慢复温，复温速率不超过0.5 ℃/6 h。常温组病人维持正常体温（36~37 ℃）。结果 低温组病人低温维持时间3~7 d，平均（4.7±1.6）d。低温启动前，两组各项指标无明显差异（P>0.05）。随治疗时间的延长，低温组病人心率、动脉pH值、动脉剩余碱和血清钾离子浓度显著低于常温组（P<0.05）。术后24~120 h，亚低温组病人颅内压、脑脊液胶质纤维酸性蛋白和泛素C末端水解酶L1水平均明显低于常温组（P<0.05）。低温组病人肺部感染发生率和低钾血症发生率较常温组明显增高（P<0.05）。发病后6个月，低温组病死率（30.8%）明显低于常温组（53.8%；P<0.05），低温组预后良好率（GOS评分4~5分，46.2%）明显高于常温组（20.5%；P<0.05）。结论 亚低温可降低自发性脑出血病人颅内压，保护脑组织，改善临床结局，但是治疗期间应注意早期防治并发症。

Curative effects of mild hypothermia on spontaneous intracerebral hemorrhage and its safety

Objective To explore the curative effect of mild hypothermia on spontaneous intracerebral hemorrhage (SIH) and its safety. Methods Seventy-eight patients with acute SIH, who were treated in our hospital from January, 2015 to March, 2017, were divided into hypothermia group, in which 39 received routine treatment and mild hypothermia therapy and normothermia group, in which 39 recived routine treatment under the normothermia. The physiological parameters, intracranial pressure (ICP) and biomarkers in the cerebrospinal fluid (CSF) were dynamically monitored in all the patients. The curative outcomes were assessed by GOS 6 months after the treatment. Results The heart rate, serum K+ concentration, blood pH, blood residual alkali concentration, CSF glial fibrillary acid protein and ubiquitin carboxy terminal hydrolase L1 levels and ICP were significantly lower in the hypothermia group than those in the normothermia group 24, 48, 72 and 120 hours after the treatment (P<0.05). The six-month following-up results showed that the mortality and rate of unfavorable outcome in hypothermia group was significantly lower than those in the normothermia group (P<0.05). However, the occurrence rate of complications such as pulmonary infection and hypokalemia was significantly higher in the hypothermia group than that in the normothermia group (P<0.05). Conclusions It is suggested that mild hypothermia therapy can reduce ICP and protect the injured brain tissues and improve the prognoses in the patients with SIH. Adequate attention should be paid to the monitoring of physical parameters and relevant complications.