局部亚低温治疗对急性脑出血患者应激激素的影响

目的观察局部亚低温治疗对急性脑出血患者应激激素的影响。方法将78例脑出血患者随机分为亚低温组(38例)和常规治疗组(40例),两组在常规药物综合治疗基础上,亚低温组加用局部亚低温治疗;观察两组治疗前、治疗后第3d、第7d血浆促肾上腺皮质激素(ACTH)、促肾上腺皮质释放激素(CRH)、皮质醇(CS)和醛固酮(ALD)的变化,并与健康对照组比较;比较各组治疗前、治疗第21d两组临床神经功能缺损程度评分(NDS)及疗效。结果两组患者治疗前ACTH、CRH、CS和ALD水平与健康对照组比较明显增高(均P<0.01);治疗第3d、第7d逐步下降,与常规治疗组相比亚低温组各项指标下降更明显(均P<0.01)。治疗第21d亚低温组NDS评分明显低于常规治疗组(P<0.05),显效率、总有效率明显高于常规治疗组(均P<0.01)。结论局部亚低温治疗可降低脑出血患者应激激素分泌,促进患者神经功能恢复,明显改善预后。

Effect of local mild hypothermia therapy on stress hormones in patients with acute cerebral hemorrhage

Objective To investigate the effect of local mild hypothermia on stress hormones in patients with acute cerebral hemorrhage.Methods 78 patients were randomly divided into two groups, mild hypothermia group (38 cases) and routine group (40 cases). Conventional treatment was used in both groups, and local mild hypothermia therapy was applied in mild hypothermia group. The concentrations of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), corticosteroid (CS) and aldosterone (ALD) in plasma pretherapy and at 3rd, 7th day after treatment were measured. The scores of clinical neurological deficit prior and at 3rd week after treatment were observed.Results The levels of plasma ACTH, CRH, CS and ALD prior treatment both in mild hypothermia and routine group were higher than those in healthy control group (all P<0.01), and they decreased gradually as time went on. The concentrations of ACTH, CRH, CS and ALD in plasma of mild hypothermia group were significantly lower than those of routine group at 3rd and 7th day after treatment (all P<0.01). Compared with routine group at 3rd week after treatment, the scores of clinical neurological deficit were significantly lower (P<0.05), the excellence rate and effective rate were significantly higher (all P<0.01) in mild hypothermia group.Conclusion Local mild hypothermia therapy can obviously inhibit the secretion of stress hormones, promote the recovery of neurological function deficit and significantly ameliorate the prognosis of the patients with cerebral hemorrhage.