早期机械通气配合亚低温治疗在重型颅脑损伤中的应用

目的 探讨早期机械通气配合亚低温治疗在重型颅脑损伤治疗中的作用及临床意义。方法 对2001年6月～2004年12月间收治的49例重型颅脑损伤患者伤后或术后即给予机械通气辅助氧供并同时冰毯降温，观察治疗前、后PaO2，GCS评分，lung injury score（LIS评分），acute lung injury（ALI）指数，颅内朦（ICP）变化。结果 49例患者经治疗后，上述指标均明显改善，血气分析指标基本恢复正常水平。全组死产8例，自动出院2例，死亡率（包括自动出院）20．41％。出院病人39例获随诊半年。恢复良好31例，中残3例。重残2例，植物状态3例。结论 早期气管切开、机械通气，配合亚低温治疗，可控制和预防低氧血症，改善脑缺血，减轻脑水肿和颅内高压。对疾病预后有重要意义。

Application of early mechanical ventilation coupled with mild hypothermic therapy on severe craniocerebral injuries

Objective To probe into the curative effect and the clinical significance of early mechanical ventilation together with subhypothermic therapy in the treatment of severe craniocerebral injuries. Methods From June 2001 to December 2004, 49 cases of severe craniocerebral injuries were immediately treated with mechanical ventilation and ice-blanket cooling after injuries or surgery. Before and after the treatment, the observation was made in PaO2, GCS, lung injury score (LIS), indices of acute lung injury (ALI) and variations of intracranial pressure (ICP). Results All of the 49 cases treated with early mechanical ventilation coupled with subhypothermic therapy had obvious improvements in GCS, LIS, indices of ALI and ICP. The indices of blood gas analysis were found to have returned to almost normal levels. Among the whole group, 8 cases ended in death and 2 in leaving the hospital automaticly. 39 patients discharged from hospital were given a 6-month follow-up, among which 31 cases were deemed to have recovered quite well or to be slightly disable, 3 cases were moderately disable, 2 cases were severe disable and 3 in a vegetative state. Conclusion The early tracheotomy and the correct application of mechanical ventilation together with subhypothermic therapy can control and prevent hypoxemia, improve cerebral ischemia and relieve cerebral edema and intracranial hypertension, which are of great significance for the prognosis of the patients.