亚低温治疗外伤性急性弥漫性脑肿胀的临床研究  

Clinical Study on Mild Hypothermia Treatment for Posttraumatic Acute Diffuse Brain Swelling

作　　者：廖圣芳[1] 王汉东[2] 陈汉民[1] 王玉差[1] 张银清[1] 

机构地区：[1]福建泉州解放军第180医院神经外科,泉州362000 [2]江苏南京解放军南京总医院神经外科,南京210002

出　　处：《中国临床医学》2005年第3期373-375,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨亚低温治疗外伤性急性弥漫性脑肿胀(PADBS)的机理与疗效。方法:选择伤后12h内入院的PADBS患者46例(实验组)接受亚低温治疗,同期入院常温下治疗的同类患者46例作为对照组;所有患者其他治疗措施均基本相同。同时监测病人的生命体征、颅内压(ICP)、脑灌注压(CPP)、血糖、血乳酸、血气、血电解质。均于伤后3个月时根据GOS评估法判定疗效。结果:与对照组相比,亚低温治疗组病人伤后早期的高ICP、高血糖、高乳酸血症分别明显下降(P<0.01),低CPP明显上升(P<0.01);生命体征、血气及血电解质无显著差异;无严重并发症。将恢复良好、中残、重残合称为治疗有效,将植物生存、死亡合称为治疗无效。治疗组治疗有效率显著高于对照组(P<0.05),而治疗无效率显著低于对照组(P<0.05)。治疗组觉醒天数显著短于对照组(P<0.01)。结论:PADBS患者早期应用亚低温治疗可明显提高临床疗效,缩短昏迷时间,无严重并发症,值得临床推广应用。Objective: To study the therapeutic mechanism and effect of mild hypothermia on the patients with posttraumatic acute diffuse brain swelling(PADBS). Methods: All 92 patients with PADBS (Glasgow coma scale score of 8 or less on admission)were randomly divided into the treated group(46 cases) and the control group(46 cases). The treated group were treated with mild hypothermia and the control group treated with normal temperature. Meantime, the vital sign, mtracranial pressure(ICP), cranial perfusion pressure(CPP),glucemia, blood lactate,blood gas values,blood electrolytes were measured. According to Glasgow Outcome Scale(GOS), the prognosis of the patients was evaluated. Results: In comparison with control group,during mild hypothermia, increased ICP,hyperglycemia,raised blood lactate significantly decreased(P<0. 01) ,and decreased CPP significantly increased(P<0. 01). 19 cases were treated effectively and 27 cases treated effectless in the treated group while to the control group,10 and 36 cases respectively;The difference was significant (P<0.05). The time of awakening and conscious recovery in the treated group were shortener than that in control(P<0.01). Conclusion: The effect of patients with PADBS can be improved by administration mild hypothermia and deserves further clinical applications.

关 键 词：外伤性急性弥漫性脑肿胀(PADBS) 亚低温 治疗 预后 

分 类 号：R741[医药卫生—神经病学与精神病学]