亚低温治疗重度颅脑损伤68例对照研究

目的　探讨亚低温治疗重度颅脑损伤患者的作用机制及疗效。方法　 6 8例GCS≤ 8分服重度颅脑损伤患者于创伤后 2 4h内接受亚低温治疗 ,控制直肠温度在 32℃～ 34℃ ,颅内压降至正常后再持续维持低温 2 4～ 4 8h ,然后缓慢复温。监测和记录治疗前后的脑组织氧分压、颅内压、血糖及重要脏器功能指标 ,于伤后 6个月根据GOS标准进行评估 ,并与对照组比较。结果　治疗后患者脑组织氧分压明显升高 (P <0 .0 5 ) ,颅内压明显降低 (P <0 .0 5 ) ,对创伤后早期发生的高血糖反应有抑制作用 (P <0 .0 5 )。GOS评估显示亚低温治疗组患者恢复良好率为 6 9.2 % ,病死率12 .3% ,与对照组比较 (分别为 33.3%和 2 8.5 % )有显著性差异 (P均 <0 .0 5 )。结论　亚低温治疗重度颅脑损伤是一种安全、有效的方法。

A control study on mild hypothermia in treatment of severe craniocerebral injury

Objective To study the mechanism and the therapeutic effects of mild hypothermia on patients with severe craniocerebral injury.Method The mild hypothermia treatment was applied in 68 patients with severe craniocerebral injury within 24 h after injury,the patients,Glasgow coma scale was ≤8 at admission.The rectal temperature of patients was kept at 32～34℃ and lasted 24～48 h after the lowering to normal of intracranial pressure,then the patients were slowly rewarmed within 12h or more.The pressure of brain tissue oxygen (pbro2 ),intracranial pressure (ICP),blood sugar (BS) and parameters of important organs function were simultaneously monitored and recorded pre- and post-treatment.Prognosis was evaluated according to Glasgow Outcome scale (GOS) at 6 months after injury and compared with that in control group.Results Compared with controls group,the mild hypothermia treatment could significantly elevate PbrO_2( P <0.05)and reduce ICP( P <0.05)and the increasing BS level,and have inhibition for hyperglycemia response at the early stage after injury( P <0.05.The GOS assessment indicated that 69.2% patients who received mild hypothermia treatment had good recovery,and mortality rate was 12.3%,there were significant differences (both P <0.05) compared with controls(33.3% and 28.5%,respectively). Conclusion The continuous mild hypothermia treatment is an effective and safe method for patients with severe craniocerebral injury.