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。

Effects of body temperature on serum levels of ischemia-modified albumin and malondialdehyde after surgery for intracranial hematomas in patients with severe traumatic brain injury

Objective To investigate the effect of body temperature on the serum levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) after the surgery for the intracranial hematomas in patients with severe traumatic brain injury (sTBI). Methods Forty-five patients with sTBI after the surgery for intracranial hematomas were divided into observed group (n=25) and control group (n=20). In observed group, mild hypothermia therapy apparatus and hibernation drugs were used to control rectal temperature at 36.0~36.4 ℃ for 7 days. In control group, conventional cooling Methods were used to control rectal temperature at 36.5~37.7 ℃. The serum levels of IMA and MDA were detected by ELISA. Results The intracranial pressure, which began to decline 3 days after the body temperature control, was significantly lower in observed group than control group 7 days after the body temperature control (P<0.05). the="" prognosis="" was="" significantly="" better="" in="" observed="" group="" than="" control="" 3="" months="" after="" body="" temperature="" (P<0.05). there="" was="" no="" significant="" difference="" in="" the="" complications="" between="" two="" groups.="" serum="" levels="" of="" ima="" and="" mda="" were="" significantly="" lower="" observed="" group="" than="" control="" 1,="" 3,="" 5,="" 7="" days="" after="" body="" temperature="" (P<0.05).>Conclusions The rectal temperature which was controlled at the range from 36.0 to 36.4 has neuroprotection in the patients with sTBI after the removal of the intracranial hematomas probably due to the decrease in the serum levels of IMA and MDA.