局部亚低温对急性脑出血患者局部脑血流灌注的影响及其临床意义

目的研究局部亚低温对急性脑出血患者病灶区脑血流灌注的影响,探讨局部亚低温治疗脑出血的机制和临床意义。方法将急性脑出血患者36例随机分为局部亚低温组19例和甘露醇等常规治疗组17例。局部亚低温组在甘露醇等常规治疗基础上施予病灶侧局部亚低温治疗72h。对照组为20例健康体检者。应用单光子发射计算机体层成像术(SPECT)显示脑出血患者脑水肿高峰期(发病第4天)局部脑血流灌注情况,并对患者入院时及第3、7、14、21天分别行美国国立卫生研究院卒中量表(NIHSS)评分。结果脑出血患者病灶区脑SPECT血流灌注明显低于健康对照,局部亚低温与常规治疗组两组病灶区平均血流灌注对比,常规治疗组明显低于局部亚低温组(P<0.05),NIHSS评分在常规治疗组和亚低温治疗组患者在入院时,第3天和第7天无明显差异(P>0.05),第14天和第21天亚低温组明显低于常规治疗组(P<0.05)。结论局部亚低温治疗可显著改善脑出血急性期病灶区的脑血流灌注,减轻神经损伤,保护和改善急性脑出血神经功能。

The Influence of Local Mild-hypothermia Therapy on Cerebral Blood Flower In the Patients with Acute Cerebral Hemorrhage and Its Clinical Signification

Objective To study the influence of focal mild hypothermia on the regional cerebral blood flower in the patients with acute cerebral hemorrhage and to explore its clinical significance and mechanism. Methods 36 patients with acute cerebral hemorrhage were divided randomly into local mild hypothermia group and routine therapy group with mannitol. There were 19 and 17 cases in the former and latter group respectively, and the former group were treated with local mild hypothermia for 72 h based on routine therapy. The control group was 20 healthy people. The regional cerebral blood flower was determined by Single-Photon Emission Computed Tomography（SPECT） at 4th day. And the clinical status was evaluated by NIHSS dynamically before treatment and at 3rd,7th,14th and 21st day after the treatment. Results The regional cerebral blood flower in patients with acute cerebral hemorrhage was lower than that in healthy peoples（ P 〈 0.05 ）. Compared with routine therapy group, The regional cerebral blood flower was increased in local mild hypothermia group significantly （P 〈 0. 05 ）, and the NIHSS was apparently improved at 14 and 21 day after the treatment（ P 〈 0.05 ）. Conclusions The local mild hypothermia therapy could dramatically increase the regional cerebral blood flower, alleviate the severity of the damaged neurons, protect and impmve neurological function in the patients with acute cerebral hemorrhage.