重型颅脑损伤患者开颅术后亚低温治疗作用的研究

目的研究重型颅脑损伤患者开颅术后亚低温治疗的作用。方法80例重型颅脑损伤患者开颅术后被随机分成两组：脑亚低温组（A组）和常温组（B组）。利用亚低温治疗仪，对控制目标温度在脑温33—35℃，亚低温治疗4d后自然复温。具有相似性质病例的B组，使用亚低温外的常规治疗。监测两组病例的生命体征、颅内压、静脉血超氧化物歧化酶（SOD）含量、GOS评分及并发症，进行分析。结果（1）两组在24、48、72h的平均颅内压分别为（23．49±2．38）mmHg、（24．68±1．71）mmHg、（22．51±2．44）mmHg和（25．87±2．18）mmHg、（25．90±1．86）mmHg、（24．57±3．95）mmHg，前者较后者降低（P分别为0．000，0．0130及0．003）；（2）两组在3d和7d的平均SOD含量分别为（533．0±103．4）μg/L、（600．5±82．9）μg/L和（458．7±68．1）μg/L、（497．0±57．3）μg/L，前者较后者明显升高（P=0．000）；（3）1年后两组恢复良好率（GOS评分）分别为70．0％和47．5％，（P=0．041）。两组并发症的发生率（包括肺部感染）分别为57．5％和32．5％（P=0．025），处理后未见严重后果发生。结论亚低温治疗为重型颅脑损伤患者开颅术后的一种安全有效的治疗措施。

Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy

Objective To study the effects of therapeutic mild hypothennia on patients with severe traumatic brain injury after craniotomy. Methods Eighty patients with severn TBI after unilateral craniotomy were randomized into a therapeutic hypothennia group with the brain temperature maintained at 33 - 35℃ for 4 days, and a normothermia control group in the intensive care unit. Vital signs, intracranial pressure, serum superoxide dismutase level, Glasgow Coma Scale scores, and complications were prospectively analyzed. Result The mean intracranial pressure values of the therapeutic hypothermia group at 24, 48, and 72 hours after injury were much lower than those of the control group（23.49 ± 2.38mmHg, 24.68 ± 1.71mmHg, 22.51 ± 2.44mmHg and 25.87± 2.18mmHg, 25.90 ± 1.86mmHg, 24.57± 3.95mmHg, respectively）. The mean serum superoxide dismutase levels of the therapeutic hypothemfia group at days 3 and 7 were much higher than those of the control group at the same time point（533.0 ± 103.4ug/L and 600.5 ± 82.9ug/L vs 458.7 ± 68.1ug/L and 497.0 ± 57.3ug/L, respectively; P = .000）. The percentage of favorable neurologic outcome 1 year after injury was 70.0% and 47.5%, respectively（ P = .041）. Complications, including pulmonary infections（57.5% in the therapeutic hypothermia group vs 32.5% in the control group; P = 0.025） were managed without severe sequelae. Conclusion Therapeutic mild hypotherrnia provides a promising way for patients with severe TBI after craniotomy.