老年脑出血后局部亚低温治疗对应激激素变化的研究

目的研究老年人急性脑出血后局部亚低温治疗对其应激激素的影响。方法将96例老年脑出血患者随机分为局部亚低温组(47例)和常规治疗组(49例),常规治疗组单纯药物综合治疗,局部亚低温组在药物综合治疗基础上加用局部亚低温治疗,观察两组入院时、治疗后1w血浆促肾上腺皮质释放激素(CRH)、肾上腺皮质激素(ACTH)、皮质醇(Cor)的变化以及应激性疾病的改变。结果两组经治疗1w后,应激激素(ACTH、CRH、Cor)明显下降(P<0.05),应激性疾病(高血压、高血糖和应激性溃疡)明显好转(P<0.05);但同常规治疗组相比,局部亚低温组对应激激素和应激性疾病的影响更明显(P<0.05);同样,在应激性高血糖组也得到了相同的结果。结论颅脑局部亚低温治疗可稳定下丘脑垂体肾上腺(H P A)轴,显著降低脑出血的应激反应,改善应激性疾病。

Study the effect of local mild hypothermia therapy on changes of stress hormones in elderly patients with cerebral hemorrhage

Objective To investigate the effects of local mild hypothermia therapy on stress hormones in elderly patients with acute cerebral hemorrhage. Methods 96 elderly patients with cerebral hemorrhage were randomly divided into local mild hypothermia group (n=47, drugs therapy united local mild hypothermia) and routine treatment group (n=49, simplex drugs therapy). The changes of plasma corticotropin releasing hormone (CRH), adrenal cortical hormoneadreno (ACTH) and corticosteroid (Cor) and the stress diseases before treatment and at the 1st week after treatment in two groups were observed. Results The concentration of serum CRH, ACTH and Cor significantly decreased (P<0.05), and stress diseases, such as hypertension, hyperglycemia and stress ulcer, were improved significantly at the 1st week after treatment (P<0.05) in two groups. But the therapeutic effect in local mild hypothermia group was more obvious than that in routine treatment group (P<0.05). The same result was found in the stress hyperglycemia group. Conclusions Local mild hypothermia therapy could make the hypothalamic-pituitary-adrenal (H-P-A) axis stable, obviously decrease stress reaction of cerebral hemorrhage and promote the recovery of stress diseases.