亚低温治疗重型颅脑损伤的疗效及其影响因素

目的：观察亚低温治疗重型颅脑损伤的效果及影响亚低温治疗时机的相关因素。方法：80例重型颅脑损伤患者随机分为亚低温治疗组（n=39例）和常规治疗组（n=41例）。比较两组的预后，观察重型颅脑损伤亚低温治疗时间窗。分析影响重型颅脑损伤亚低温治疗时机的原因。结果：伤后3个月GOS评分：亚低温治疗组恢复良好率56．4％。显著高于对照组39．0％（P〈0．05）；亚低温治疗组病死率28．1％，明显低于对照组43．9％（P〈0．05）。亚低温治疗组开始治疗时间窗：12小时内16例。死亡3例．恢复良好8例；12时后23例。死亡8例，恢复良好10例。结论：早期亚低温治疗能显著降低重型颅脑损伤患者的死残率。合并伤、休克、迟发性颅内血肿、亚低温开始时间是影响重型颅脑损伤亚低温治疗临床疗效的主要因素。

Clinical effect and influence factors of mild hypothermia for severe craniocerebral injury

Objective:To observe the clinical effect of mild hypothermia for severe craniocerebral injury and the relative factors of affecting the therapeutic opportunity. Methods:80 patients with severe craniocerebral injury were randomly divided into treatment group(n=39) and control group (n=41). The prognosis of the two groups was compared,the therapeutic opportunity of using mild hypothermia to treat severe craniocerebral injury was observed,and the causes which affected the therapeutic opportunity of using mild hypothermia for severe craniocerebral injury were analysed. Results:GOS score was used in 3 months after injury,the good recovery rate in the treatment group was 56.4%,which was significantly higher than that in the control group(39.0%)(P<0.05);the death rate of the treatment group was 28.1%,which was significantly lower than that of the control group(43.9%)(P<0.05). The therapeutic opportunity of using mild hypothermia was as follows:there were 3 cases death and 10 good recovery in 16 cases within 12 hours;there were 8 death and 10 good recovery in 23 cases after 12 hours. Conclusion:Mild hypothermia can significantly decrease the death and disability rate,associated injury,shock and delayed intracranial hematoma. The initiative time of mild hypothermia is the mian factor which affects the clinical effect and therapeutic opportunity of using mild hypothermia for severe craniocerebral injury.