亚低温治疗对重度脑损伤继发性脑血管痉挛及脑脊液和血浆内皮素、降钙素基因相关肽的影响

目的 探讨亚低温治疗对重度脑损伤继发性脑血管痉挛及脑脊液和血浆内皮素(ET)、降钙素基因相关肽(CGRP)水平的影响.方法 65例重度脑损伤患者随机分成亚低温组(30例)和对照组(35例),两组在常规治疗的基础上,亚低温组加用局部亚低温治疗.检测两组入院时及治疗7、14d脑脊液和血浆ET、CGRP水平,并比较两组继发性脑血管痉挛的发病情况.结果 (1)脑脊液、血浆ET水平于治疗7 d时亚低温组较对照组显著减低(P＜0.05);14 d时两组差异更为显著(P＜0.01);两组脑脊液和血浆CGRP水平于治疗7 d时降至最低,后逐渐升高,治疗7、14 d亚低温组明显高于对照组(P＜0.05或＜0.01).(2)亚低温组继发性脑血管痉挛发生率为6.67%(2/30),较对照组的22.86%(8/35)明显减少(P＜0.05).结论 亚低温治疗减小了重度脑损伤患者脑脊液和血浆ET水平上升幅度及CGRP水平下降幅度,从而降低继发性脑血管痉挛的发生率.

Effects of mild hypothermia on secondary cerebral vasospusm and levels of endothelin,calcitonin gene related peptide in cerebrospinal fluid and plasma in patients with severe brain injury

Objective To study the effects of mild hypothermia on secondary cerebral vasospasm and levels of endothelin (ET),calcitonin gene related peptide (CGRP) in cerebrospinal fluid (CSF)and plasma in patients with severe brain injury(SBI).Methods Sixty-five patients with SBI were randomly divided into mild hypothermia group(30 cases)and control group(35 cases).Based on the routine treating method,the patients of mild hypothermia group were treated with local mild hypothennia.The levels of ET,CGRP in CSF and plasma were detected before and after treatment.And the incidence rates of secondary cerebral vasospasm cases were compared between the two groups.Results (1)At 7,14 day after treatment,ET levels in CSF and plasma in mild hypothermia group were significantly lower than these in control group (P＜0.05or＜0.01).The CGRP levels in CSF and plasma were the lowest at 7 day,then gradually increased in two groups.However,the CGRP levels in mild hypothermia group at 7,14 day were higher than those in control group (P＜0.05 or＜0.01).(2) The rate of secondary cerebral vasospasm in mild hypothermia group was 6.67% which significantly less than that in control group (22.86%) (P＜0.05).Conclusion Mild hypothermia can prevent the increasing of ET and the decreasing of CGRP in CSF and plasma,and decrease the incidence rate of secondary cerebral vasespasm in patients with SBI.