术中亚低温治疗急性颅脑损伤后CD4~+、CD8~+及比值变化

目的探讨术中亚低温对颅脑损伤者CD4+、CD8+变化的影响。方法选择2010年1月—2015年12月在湖北随州市曾都医院实施开颅血肿清除的患者80例,按治疗方法不同分为两组(各40例)。观察组男性29例,女性11例;年龄31~60岁,平均45.2岁;入组GCS评分8~13分,平均10.3分。对照组男性30例,女性10例;年龄31~60岁,平均45.3岁;入组GCS评分8~13分,平均10.4分。对照组行常规去骨瓣减压血肿清除术,观察组在对照组基础上结合术中亚低温,比较干预后CD4+、CD8+、CD4+/CD8+、免疫球蛋白、欧洲脑卒中评分(ESS)、Barthel指数及Fugl-Meyer评分变化情况。结果干预后观察组CD4+、CD8+高于对照组(35.1±2.0)%vs.(26.0±0.9)%,(30.6±1.3)%vs.(24.4±1.0)%,P0.05],CD4~+/CD8~+高于对照组(1.9±0.3 vs.1.6±0.2,P0.05),Ig M、Ig G、Ig A高于对照组(1.60±0.03 vs.1.32±0.02,9.52±0.12 vs.8.84±0.10,3.91±0.20 vs.1.83±0.15,P0.05),ESS、Barthel指数、Fugl-Meyer评分高于对照组(P0.05)。结论术中亚低温能有效减少手术对患者免疫功能影响,促进神经功能恢复,提高生活质量及肢体功能。

Effect of intra-operative hypothermia therapy on changes of CD4 +and CD8 +level in patients with acute head injury

Objective To investigate the effect of intra-operative hypothermia on changes of CD 4 +and CD8 +level in patients with acute craniocerebral injury .Methods Eighty patients with craniocerebral hematoma admitted between Jan.2010 and Dec.2015 were randomly divided into observation group (n=40) and control group (n=80).In the observation group,there were 29 males and 11 females,with an average age of 45.2 years (range, 31 to 60 years).The GCS score was 8 to 13 points,with an average of 10.3 points.In the control group,there were 30 males and 10 females,with an average age of 45.3 years (range,31 to 60 years).The GCS score was 8 to 13 points,with an average of 10.4 points.The control group was treated with conventional decompression and the obser-vation group was treated with conventional decompression combined with intra -operative mild hypothermia therapy . The levels of CD4+, CD8 +,CD4 +/CD8 +,the change of immunoglobulins ,ESS,Barthel index and Fugl-Meyer score after intervention were compared between the two groups .Results The levels of CD4 +,CD8 +and CD4 +/CD8 +in the observation group were higher than those in the control group ((35.1 ±2.0)% vs.(26.0 ±0.9)%,(30.6 ± 1.3)%vs.(24.4 ±1.0)%,1.9 ±0.3 vs.1.6 ±0.2,P<0.05),and the levels of IgM,IgG and IgA in the obser-vation group were significantly higher than those in the control group (1.60 ±0.03 vs.1.32 ±0.02,9.52 ±0.12 vs. 8.84 ±0.10,3.91 ±0.20 vs.1.83 ±0.15,P<0.05).The ESS,Barthel index and Fugl-Meyer score in the obser-vation group were higher than those in the control group (P<0.05).Conclusion Mild-hypothermia can reduce the influence of surgery on the immune function in patients with craniocerebral trauma ,promote the recovery of nerv-ous system and improve the quality of life and limb movement .