阶梯式亚低温治疗单纯弥漫性轴突损伤  

Treatment of diffuse axonal injury with mild-moderate posttraumatic hypothermia

作　　者：陈革[1] 周建宏[1] 陆爻忠[1] 王泳[1] 蒋云召[1] 杜梁枫[2] 徐芳[2] 冯淑静[3] 李成万[3] 

机构地区：[1]无锡市第三人民医院神经外科,214041 [2]无锡市第三人民医院NICU,214041 [3]无锡市第三人民医院中心实验室,214041

出　　处：《江苏医药》2009年第1期32-34,共3页Jiangsu Medical Journal

基　　金：无锡市社会发展科研计划资助(CS045006)

摘　　要：目的评价阶梯式亚低温治疗单纯弥漫性轴突损伤(DAI)的疗效。方法对36例单纯DAI随机分为两组:亚低温组实施阶梯式亚低温治疗,在伤后6～12h内将膀胱温度(BT)降至32.0～33.9℃,持续3d,第4～7天BT控制在34.0～35.9℃,第8～14天在36.0～36.9℃;常规治疗组作为对照。监测颅内压、血脑脊液乳酸、昏迷时间,测量伤后第3个月CT片侧脑室额角宽度、第三脑室前后径,并对患者进行功能障碍(DRS)评分。结果与常规治疗组比较,时程为2周的阶梯式亚低温组明显降低颅内压、血脑脊液乳酸,减轻额角扩大,降低DRS(P<0.01或P<0.05),而不增加亚低温并发症发生率;但亚低温期间昏迷程度不减轻,也不缩短昏迷时间。结论阶梯式亚低温其并发症未增多,可减轻DAI损伤后的脑白质性脑萎缩,改善后期神经功能,但不能减轻DAI昏迷程度和缩短昏迷时间。Objective To evaluate the outcomes of treating simple diffuse axonal injury with mild-moderate posttraumatic hypothermia of the urinary bladder. Methods Thirty-six patients with diffuse axonal injury （DAD without complicated other types of brain injury were randomly divided into hypotherrnia group and control group. The mild-moderate posttraumatic hypothermia was carried out in hypothermia group with the bladder temperature of 32. 0-33. 9℃ within 6-12 h after injury for first 3 days, 34.0-35.9℃ on the 4^th-7^th day, 36.0-36.9℃ on the 8^th-14^th day. The conventional therapy was used in control group. The intracranial pressure （ICP）, lactic acid of blood and CSF, persisting time of coma were recorded in both groups. The width of the anterior horn of lateral ventricle, the width and length of the 3^rd ventricle were measured by CT scan after 3 months. Neural functions were evaluated by disability rating scale （DRS）. Results Compared with control group, ICP and laetic acid in blood and in CSF of hypothermia group were significantly reduced,and anterior horn of lateral ventricle enlarging and the score of DRS were decreased （P〈0. 01 or P〈 0. 05）, The complications were not increased in hypothermia group. Hypothermia did not lighten the degree of coma or shorten the course of coma. Conclusion The mild-moderate posttraumatic hypotherrnia of the urinary bladder could reduce encephalatrophy for white matter damage and ameliorate neural functions in later stage of injury.

关 键 词：亚低温治疗 弥漫轴突损伤 

分 类 号：R651[医药卫生—外科学]