亚低温治疗高温高湿环境下重型颅脑损伤的临床观察  

Clinical Observation of Curative Effect of Mild Hypothermia on Patients with Severe Head Injury in Hot and Humid environment

作　　者：谢培增 周赤龙 朱红胜 何强华 王松青 李扬 肖现 谢星 刘君 

机构地区：[1]解放军422医院神经外科,湛江524005

出　　处：《华南国防医学杂志》2006年第6期22-24,共3页Military Medical Journal of South China

基　　金：广州军区卫勤课题项目(2001A12)

摘　　要：目的观察亚低温治疗高温高湿环境下重型颅脑损伤的疗效,探讨亚低温治疗的平稳性和安全性。方法将200例高温高湿环境下重型颅脑损伤病人随机分为亚低温组(100例)和对照组(100例),亚低温组入院后或术后立即行亚低温治疗,酌情运用冬眠合剂、肌松剂和呼吸机,肛温控制在33℃~35℃,持续24h^5天。对照组行常规治疗。两组均观察颅内压(1CP)、生命体征、脑干听觉诱发电位(BAEP)I/V波幅比值等的变化。结果亚低温组经亚低温治疗后,ICP下降明显;23例血压下降,24例心率减慢,复温后以上指标均恢复正常;亚低温治疗后24h及复温后、双侧BAEPI/V比值与对照组同时间相比差异显著(P<0.05)。亚低温组死亡39例,死亡率39%;对照组死亡52例,死亡率52%,两组有显著性差异(P<0.05)。结论亚低温治疗高温高湿环境后重型颅脑伤能降低脑外伤后增高的ICP,从而使死亡率及致残率明显下降,亚低温治疗中合理使用辅助药物,可以保障亚低温治疗的平稳性和安全性。Objective To study the clinical effects of mild hypothermia treatment on patieants with severe head injury in hot and humid environment and its safety. Methods Two hundred patients with severe head injury in hot and humid environment were randomly divided into mild hypothermia group（ 100 cases） and control group（ 100 cases）. The patients in the hypothermia group were treated by mild hypothermia,keeping the anal temperature at 33℃～35℃ from 24 hours to 5 days. The lyric cocktail, paramyon, respiratory aid were given in the hypothermia group if necessary. The patients in control group received routine treatment. The level of intracranial pressure （ ICP）, life signs and brainstem auditory evoked potential （ BAEP） were measured in the both groups. Results The level of ICP reduced significantly ,blood pressure lowered in 23 cases,and heart rate reduced in 24 cases after mild hypothermia treatment. All the above-mentioned parameters were normal after the temperature returned to normal level. Thirty- nine patieits died in the hypothermia group（ 39 % ）, and 52 died in the control group（ 52% ）. There was significant difference in the mortality between these two groups（ P〈0.05 ）. Conclusion The high level of ICP caused by severe head injury in hot and humid can be reduced and the mortality rate can be decreased by mild hypothermia treatment. The supplementary medicine used properly can ensure the safety of the mild hypothermia treatment.

关 键 词：高温高温环境 颅脑损伤 亚低温 治疗 

分 类 号：R651[医药卫生—外科学]