选择性脑亚低温治疗对防治重型颅脑损伤后常见并发症的作用  

The effects of selective brain cooling on prevention and treatment of common complications of severe brain injury

作　　者：杨长虹[1] 柳浩然[1] 薄巍巍[1] 吴海权[1] 郎明渝[1] 辛续伟[1] 陈风华[2] 方加胜[2] 

机构地区：[1]武警广东公安边防总队医院神经外科,广东深圳518029 [2]中南大学湘雅医院神经外科,湖南长沙410008

出　　处：《中国耳鼻咽喉颅底外科杂志》2006年第6期410-413,417,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 研究选择性脑亚低温对急性重型颅脑损伤病人早期常见并发症的预防及治疗作用。方法87例病人随机分为两组：亚低温治疗组和对照组。亚低温治疗组均于伤后24h内行脑亚低温治疗，脑温控制在32．0＇U～35．0℃，持续1～7d。对照组43例，未实行脑亚低温疗法，其他脱水、利尿、止血、抗炎等常规治疗同亚低温组。监测病人治疗后1周内的颅内压（ICP）、血糖变化，统计迟发性颅脑损伤、癫痫、脑血管痉挛、应激性溃疡等损伤后并发症的发生率。两组病人均于伤后3个月时根据GCs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、迟发性颅脑损伤、癫痫、脑血管痉挛等并发症发生率显著下降（P〈0．05），但应激性溃疡发生率两组无显著性差别。亚低温组预后显著改善。结论选择性脑亚低温可有效减少重型颅脑损伤早期的并发症，改善病人预后。Objective To study the effects of selective brain cooling （SBC） on prevention and treatment of the early common complications of the patients with severe brain injury. Methods 87 patients with severe brain injury were randomly divided into SBC group and control group. 44 patients of SI3C group were implemented SBC in 24 hours after injury, controlling the brain temperature at 32＂C to 35＂C and lasting 1 to 7 days. Except for S13C, the patients of control group were treated as the same as SBC group such as dehydration, diuresis, hemostasis and so on. The intracranial pressure （ICP） and blood sugar values were examined one week after therapy. The incidence of delayed brain injury, epilepsy, cerebrovascular spasm and stress ulcer was calculated. The prognosis was evaluated according to Glasgow outcome scale （GOS）. Results In comparison with the control group, the incidence of increased ICP, hyperglycemia, delayed brain injury, epilepsy, and cerebrovascular spasm decreased significantly in SBC group （ P d0. 05）, while the difference of stress ulcer rate was statistically insignificant. The prognosis of the patients in SI3C group was much better. Conclusions Selective brain cooling is effective for preventing the early complications of the patients with severe brain injury, therefor can improve the prognosis.

关 键 词：脑损伤/治疗 脑损伤/诊断 预后 低温 人工 

分 类 号：R651.15[医药卫生—外科学] R614.25[医药卫生—临床医学]