围术期亚低温治疗重型颅脑损伤的临床观察

目的通过对重型颅脑损伤患者术中进行亚低温治疗后的疗效观察，探讨围术期亚低温疗法对此类患者的脑保护作用及临床意义。方法56例重型颅脑损伤患者（GCS评分3—8分）随机分为亚低温治疗组和对照组。亚低温组患者伤后入手术室行亚低温治疗，脑温控制于32℃～35℃；对照组行常温治疗。治疗过程中观察两组患者的颈动脉和颈静脉血气、电解质变化、颅内（ICP）和脑组织氧分（PbtO2）PEA压、心率、呼吸等生命体征。对两组患者的预后情况进行GOS评分。结果亚低温治疗组患者的脑氧摄取（CEO2）和脑动静脉氧压差（A—VDO2）均明显低于对照组，差异均有统计学意义（t分别=14．89、10、19，P均〈0．05）；亚低温治疗组患者的高ICP于术后3、7d明显低于对照组，差异均有统计学意义（t分别=2．79，6．89，P均〈0．05）；亚低温治疗纽患者的PbtO2于术后3d起就明显高于对照组患者，差异均有统计学意义（t分别=4．11、6．90，P均〈0．05）；经GOS预后评分，亚低温治疗组患者中恢复良好67．86％（19／28）与对照组39．28％（11／28）比较，差异有统计学意义（X^2-3．42，P〈0．05）；死亡率为14．29％（4／28），与对照组32．14％（9／28）比较，差异有统计学意义（X^2=4．41，P〈0．05）。结论围术期亚低温治疗能降低脑外伤后升高的ICP，提高PbtO2,具有明显的脑保护作用，能有效改善重型颅脑损伤患者的预后．无严重并发症.

Clinical observation of perioperative mild hypothermia therapy in patients with severe brain injury

Objective To explore cerebral protective effect and clinical significance of perioperative mild hypothermia therapy in patients with severe brain injury. Methods Fifty six patients with severe craniocerebral injury were randomly divided into treatment group （n=28） and control group （n=28）.After entered into operation room,mild hypothermia therapy group received cooling 32-35℃ ,control group received room temperature. Carotid artery and vein blood gas , electrolyte, ICP, PbtO2, blood pressure,HR during the course of the treatment were observed. Prognosis of patients in two groups was evaluated by GCS. Results The results of the mild hypothermia therapy group were significantly lower than those of the controls （t=14.89, 10.19, P〈0.05） in CEO2 and A-VDO2. The results of the mild hypothermia therapy group were significantly lower than those of the controls （t=2.79,6.89, P〈0.05） in ICP at 3-7d after operation.The results of the treatment group were significantly lower than those of the controls （t=-4.11,6.90,P〈0.05） in PbtO2 3 days postoperative. Evaluated by GCS score, 19 patients recovered well （67.86%）,4 patients died （14.29%） in mild hypothermia therapy group,and 11 patients recovered well （39.28%）,9 died （32.14%）in control group. There were significantly differences between two groups （X^2=3.42,4.41,P〈0.05）.Conclusions The treatment of perioperative mild hypothermia can decrease ICP,increase PbtO2 in brain injury and protect brain remarkably. Also it can effectively improve prognosis of severe brain injury without serious complications.