亚低温治疗对重型颅脑损伤患者血浆一氧化氮含量的影响  

Effect of mild hypothermia on plasma nitric oxide in patients with severe brain injury

作　　者：姜德华[1] 王博[1] 孙飞[1] 王晓猛[2] 

机构地区：[1]江苏省徐州市中心医院神经外科,221009 [2]江苏省徐州市中心医院重症监护室,221009

出　　处：《中华脑科疾病与康复杂志（电子版）》2012年第4期16-19,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的 探讨一氧化氮(NO)在重症颅脑外伤患者中的作用和亚低温脑保护作用机制。方法 将2010年1月至2012年1月徐州市中心医院收治的50例重症颅脑外伤患者随机分为亚低温组(25例)和常规治疗组(25例),对照组为健康体检合格者,按照脑外伤常规治疗,亚低温组在此基础上给予亚低温治疗,联合冬眠合剂持续微量泵静脉注入、镇静止痛药物间断微量泵静脉注人等措施维持目标体温。重型颅脑损伤患者在伤后1、2、3、7及10 d抽取空腹肘静脉血2ml。采用Griess比色法间接测定NO含量。对照组、常规治疗组及亚低温治疗组组间及组内不同时间、年龄、格拉斯哥昏迷评分(GCS)、创伤指数、血浆NO采用t检验,不同组预后比较采用x2检验。伤后6个月根据格拉斯哥预后(GOS)分级评分判定疗效。结果 重型颅脑损伤常规治疗组伤后1d、2d血浆NO含量[(90.1±24.9) μmol/L、(124.1±27.3) μmol/L]较正常对照组比较,明显升高,伤后3d血浆NO含量[(143.6±30.5) μmol/L]达到峰值,7d有所下降,但仍高于对照组(t=5.31,P＜0.01),10 d后基本恢复正常。亚低温治疗组伤后1、2、3及7d,血浆NO含量较常规治疗组明显降低(t2d=4.88,t3d=5.43,P＜0.01或t1d =2.13,t7d=3.72,P＜0.05),但仍高于对照组,10 d后基本恢复正常。伤后6个月亚低温组预后良好率明显高于常规组(x2=5.33,P＜0.05)。两组预后良好者(20例)伤后1d、2d、3d、7d、10 d血浆NO含量分别低于两组预后不良者(30例)(t=2.98 ～7.19,P＜0.01)。结论 亚低温治疗的脑保护作用可能与抑制NOS活性,减少NO的合成和释放有关。Objective To investigate the role of nitric oxide( NO) in patients with severe brain injuries and the mechanism of mild hypothermia on brain protection. Methods Fifty patients with severe brain injury of Xuzhou Center Hospital from Jan. 2010 to Jan. 2012 were randomly divided into two groups,the mild hypothermia group( 25 cases) and the routine group( 25 cases),the controls were those who passed the physical examination,the mild hypothermia group was given hypothermia treatment combined with cockstailytic continued micro- pump intravenous injection and analgesic drug discontinuous micro pump infusion based on the routine treatment of severe brain injury. Extract elbow vein blood 2 ml from patients with severe brain injury at 1,2,3,7,10 d after injury respectively. The content of NO was measured by Griess colorimetric indirectly. Time,age,Glasgow coma scale( GCS),trauma index,plasma NO of control,routine,and mild hypothermia group were compared by t test,the prognosis was compared by χ2test. The curative effect was evaluated by Glasgow outcome score( GOS) after 6 months in both groups. Results In the routine treatment of severe brain injury,compared to the control group,the plasma NO was significantly higher in 1and 2 days after injury[( 90. 1 ± 24. 9) μmol / L,( 124. 1 ± 27. 3) μmol / L],in 3 days after injury,the plasma NO reached peak levels[( 143. 6 ± 30. 5) μmol / L],and decreased in 7 days,but still higher than that in control group( t = 5. 31,P < 0. 01),10 d basically returned to normal. In hypothermia treatment group after 1,2,3,7 d injury,plasma NO decreased significantly compared with routine treatment group( t2 d= 4. 88,t3 d=5. 43,P < 0. 01 or t1 d= 2. 13,t7 d= 3. 72,P < 0. 05),but still higher than that in control group,and returned to normal 10 days after injury. The good prognosis rate of mild hypothermia groups was significantly higher than routine group( χ2= 5. 33,P < 0. 05). The content of NO of the two groups with good prognosis( n = 20) at1 d,2 d,3 d,7 d,10 d after injury were lower than

关 键 词：颅脑损伤 一氧化氮 一氧化氮合酶 亚低温 

分 类 号：R651.15[医药卫生—外科学]