急性重症颅脑损伤的亚低温治疗

目的　研究亚低温对急性重型颅脑损伤病人治疗作用及临床效果。方法　共 6 8例病人 (GCS昏迷≤ 8分 )随机分为亚低温治疗组和对照组。亚低温治疗组 34例 ,均于伤后 2 4h内行亚低温治疗。直肠温度控制在 33～35 .5℃ ,持续 1～ 7天 ,平均 (6 5 .3± 2 8.2 )h。同时监测病人的生命体征、颅内压 (ICP)、血气、血电解质及动脉血氧饱和度。对照组 34例 ,直肠温度控制在 36 .5～ 37.5℃ ,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颅内压显著下降 (P <0 .0 5 ) ;生命体征、血气及血电解质、动脉血氧饱和度无显著差异 ;无严重并发症 ,病死率降低 ,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 ,用于治疗急性重型颅脑损伤病人 ,可降低病死率 ,提高生存质量 ,无严重并发症。

Mild hypothermia on patients with severe brain injury

Objective To study the effects of mild hypothermia on the patients with severe brain injury . Methods All the 68 patients with severe injury (Glasgow coma scale of 8 or less on admission ) were randomly divided into the hypothermic group (34 cases) and the control group (34 cases), which were all treated with hypothermia within 24 hours of injury. Rewarming was begun (average 65.3±28.2 hours) after the rectal temperature(RT) reached 33.0～35.5 ℃ and lasted for 1～7 days. Meantime,the vital signs, intracranial pressure(ICP), blood gas values, blood electrolytes, blood oxygen pressure were measured . The rectal temperature of control patients was controlled between 36.5～37.5 ℃, According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evalued at the end of the 3rd months.Results In comparison with control group ,the ICP of the patients in the hypothermic group significantly decreased (P<0.05) , while the vital sign, blood gas values and blood electrolytes did not significantly change. The decreased mortality and satisfying recovery were also found in hypothermia group . Conclusion Mild hypothermia is safe and effective for protecting brains of the patients with severe brain injury , which can reduce the mortality and improve the prognosis.