长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响

目的:探讨长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响。方法:62例重度颅脑损伤患者根据治疗方式不同将其分为短时程（2 d）亚低温治疗组（对照组, n=30）和长时程（5 d）亚低温治疗组（观察组, n=32），治疗后第6天时比较两组患者凝血功能指标、脑损伤标志物、氧化应激指标、并发症发生情况，随访期间观察患者昏迷时间及30 d致残率与30 d病死率。结果:治疗后第6天时，观察组血清凝血酶原时间、凝血酶时间、活化部分凝血酶原时间水平高于对照组（P<0.05），观察组血清D-二聚体水平低于对照组（P<0.05）。治疗后第6天时，观察组患者血清髓鞘碱蛋白、神经元特异性烯醇化酶、S100蛋白、丙二醛、超氧化物歧化酶水平均低于对照组（P<0.05）。两组患者颅内血肿、胃肠动力减弱、泌尿系感染、肺部感染、应激性溃疡发生率无统计学差异（P>0.05）。观察组患者昏迷时间较对照组缩短（P<0.05）；观察组患者30 d致残率及30 d病死率均低于对照组，但两组间差异无统计学意义（P>0.05）。结论:长时程亚低温治疗有利于改善重度颅脑损伤患者凝血功能，降低脑损伤标志物水平及氧化应激损伤，缩短昏迷时间，且不增加并发症发生风险。

Effects of long-term mild hypothermia on brain injury markers and oxidative stress indexes in patients with severe traumatic brain injury

Abstract: Objective To investigate the effects of long-term mild hypothermia therapy for severe traumatic brain injury on brain injury markers and oxidative stress indexes. Methods Sixty-two patients with severe traumatic brain injury were divided into short-term (2 d) mild hypothermia group (control group, n=30) and long-term (5 d) mild hypothermia group (observation group, n=32) according to their therapy methods. After 6 days of treatment, coagulation function indexes, brain injury markers, oxidative stress indexes and occurrence of complications were compared between two groups. Moreover, coma duration, 30-day disability rate and 30-day mortality rate were observed during follow-up. Results After 6 days of treatment, compared with those in control group, the levels of serum prothrombin time, thrombin time, activated partial prothrombin time in observation group were higher (P<0.05), but the serum D-dimer level was lower (P<0.05). In addition, the levels of serum myelin basic protein, neuron specific enolase, S100 protein, malondialdehyde and superoxide dismutase in observation group were lower than those in control group (P<0.05). No significant difference was found in the incidences of intracranial hematoma, reduced gastrointestinal motility, urinary tract infection, pulmonary infection and stress ulcer between two groups (P>0.05). The coma duration of observation group was shorter than that of control group (P<0.05) and the 30-day disability rate and 30-day mortality rate of observation group were lower than those of control group, but there was no significant difference between two groups (P>0.05). Conclusion Long-term mild hypothermia can improve the coagulation function of patients with severe traumatic brain injury, reduce brain injury marker levels and oxidative stress injury, and shorten coma duration, without increasing the risk of complications.