局部亚低温辅助治疗对老年脑出血患者应激反应的影响

目的研究局部亚低温辅助治疗对老年人急性脑出血患者应激激素及应激性疾病的影响。方法将96例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,常规治疗组仅采用药物综合治疗,局部亚低温组在药物综合治疗的基础上加用局部亚低温治疗,观察2组入院时、治疗后1周血浆CRH、ACTH、Cor、AVP的变化以及应激性疾病的改变。结果2组患者治疗1周后,应激激素(CRH、ACTH、Cor、AVP)较治疗前明显下降(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),且局部亚低温组应激激素水平和应激性疾病的变化更明显(P<0.05)。结论颅脑局部亚低温治疗可显著抑制脑出血的应激反应,稳定下丘脑-垂体-肾上腺(H-P-A)轴,改善应激性疾病,是亚低温治疗的另一条脑保护机制。

Effects of local mild hypothermia auxiliary therapy on stress reaction in elderly patients with cerebral hemorrhage

Objective To investigate the effects of local mild hypothermia auxiliary therapy(LMHAT) on stress hormones and stress diseases in elderly patients with acute cerebral hemorrhage. Methods Ninety-six patients were randomly divided into two groups: a local mild hypothermia group (47 cases, LMH group) and a routine treatment group (49 cases, RT group). Thirty-two healthy men who came for health examination were recruited and served as healthy control (HC group). Routine treatment were used in both treatment groups, in addition, the LMHAT was just applied in LMH group. The changes of the concentrations of corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH), corticosteroid (Cor), arginine vasopressin (AVP) in serum and the symptoms of the stress disease (hypertension, high blood sugar and stress ulcer) were observed before treatment and 1 week after treatment. Results The concentrations of CRH, ACTH, Cor, AVP in serum and the symptoms of stress disease in LMH group and RT group were improved significantly at 1 week after treatment (P<0.05), but the therapeutic effects of LMH group were better than that of LMH group (P<0.05). Conclusion LMHAT, another cerebral therapeutic mechanism of local mild hypothermia, could significantly inhibit the secretion of stress hormones, make the Hypothalamic-Pituitary-Adrenal (HPA) axis stable and promote the stress disease recovery.