脑出血病灶侧局部亚低温与全头低温治疗的临床对比观察

目的　探讨局部亚低温治疗对脑出血患者预后的影响。方法　对脑出血患者 ,给予出血侧大脑半球局部亚低温治疗。设定制冷器温度为 8℃～ 12℃ ,计算颅内出血区温度为 33℃左右 ,治疗时间为 72h。与全头低温组和常温治疗组进行比较 ,统计治疗前及治疗后 5、14d时患者神经功能缺损程度评分 ,并测定治疗前及治疗后 3、5d时患者血清神经元特异性烯醇化酶 (NSE)的含量。结果　治疗 5d和 14d时局部亚低温组、全头低温组、常温组患者神经功能缺损程度评分 (欧洲卒中量表 )较常温组有明显升高 ,5d时分别为 5 4 12±11 2 2 ,5 4 91± 10 0 7和 39 16± 8 71,14d时分别为 77 2 4± 2 0 32 ,75 2 3± 19 36和 5 1 4 1± 12 4 3,差异明显 (P<0 0 5 )。治疗 3d、5d时 ,3组血清NSE含量不同 ,3d时分别为 (15 5 3± 4 93)ng/ml,(16 2 1± 5 2 4 )ng/ml和(2 0 2 6± 9 0 4 )ng/ml;5d时分别为 (12 32± 4 0 3)ng/ml,(14 0 7± 4 31)ng/ml和 (18 12± 5 97)ng/ml ,差异显著(P <0 0 1)。结论　局部亚低温治疗对出血后的脑组织具有明显的保护作用 ,且无明显的并发症

Clinical Comparative Study of Local Mild Hypothermia on Treating Cerebral Hemorrhage

Objective To study the effect of local mild hypothermia on the prognosis of patient with cerebral hemorrhage. Methods A local hypothermia was given to the hemisphere on the hemorrhage side of cerebral hemorrhage. The preparing temperature of cryostat was 8 ℃～12 ℃ and the temperature of the intracranial area was about 33 ℃. The duration of temperature was 72 hours. The neural functional deficit of patient was calculated before and at 5, 14 days after the treatment. Meanwhile, the serum neuron-specific enolase (NSE) was measured before and at 3, 5 days after the treatment, both were compared with the control group. Results The score of neural functional deficit in the treatment group was significantly higher than that of the control group, which were 54.12±11.22, 54.91±10.07 and 39.16±8.71 on the 5th day, 77.24±20.32, 75.23±19.36 and 51.41±12.43 on the 14th day respectively P<0.05. The NSE was significantly different which were 15.53±4.93, 16.21±5.24 and 20.26±9.04ng/ml on the 3rd day, and 12.32±4.03, 14.07±4.31 and 18.12±5.97ng/ml on the 5th day respectively P<0.01. Conclusion The local mild hypothermia might have a tangible protective effect to the tissue of the brain and no obvious complication was observed.