亚低温疗法对重型颅脑损伤患者脑缺血再灌注期的影响及意义  

Effect of mild hypothermia on the cerebral hypoperfusion-hyper perfusion phases in patients with severe traumatic brain injury

作　　者：夏永勤[1] 严丽丽[1] 刘绍明[1] 徐如祥[2] 王清华[2] 

机构地区：[1]兰州军区乌鲁木齐总医院,乌鲁木齐830000 [2]第一军医大学珠江医院

出　　处：《山东医药》2009年第30期7-9,共3页Shandong Medical Journal

基　　金：中国人民解放军兰州军区医药卫生科研基金重点资助项目(LHX-2007010);全军临床医学中青年人才培养基金资助项目

摘　　要：目的观察亚低温疗法对重型颅脑损伤（sTBI）患者脑缺血再灌注期的影响,并探讨其临床意义。方法将36例sTBI患者（GCS≤8分）随机分为对照组和治疗组,各18例。伤后0、1、3、7、14、21 d用脑循环动力学（CVDI）检测仪检测CVDI。对照组维持正常体温,治疗组在伤后4～8 h将肛温降至33℃,维持3～5 d。比较两组CVDI参数、伤灶脑水肿大小和预后不良（GOS〈3分）率。结果与正常组（24例查体正常者）比较,对照组伤后CVDI可划分为4个期,即低灌注期（0 d）、高灌注期（1～3 d）、脑血管痉挛期（4～14 d）、好转期（〉15 d）;治疗组仅表现出3个期,即低灌注期（0 d）、好转期（1～3 d）、恢复期（〉4 d）,未出现高灌注期和脑血管痉挛期。伤后第14天,对照组伤灶脑水肿体积最大,为（140.9±22.95）cm^3,治疗组为（81.72±15.95）cm^3,两组相比,P〈0.05。伤后1周内对照组清醒率为22.2%（4/18）,治疗组为55.6%（10/18）,两组比较,P〈0.05。随访3 a时,对照组预后不良率为55.6%（10/18）,治疗组为22.2%（4/181）,两组比较,P〈0.05。结论亚低温治疗能降低sTBI后大脑急性高灌注并改善迟发性低灌注，缩短患者昏迷时间，减轻脑水肿，从而改善预后。Objective To investigate the effect of mild hypothermia on cerebral hyperfusion-hyper perfusion phases in severe traumatic brain injury（sTBI） patients and its clinical significance.Methods Thirty-six patients with sTBI（GCS≤8） were randomly divided into the conventional therapy group（control group） and the mild hypothermia therapeutic group（therapeutic group）,with 18 patients in each.The cerebrovascular hemodynamic indices（CVDI） was measured in 0,1,3,7,10,14,21 days after sTBI with the cerebrovascular hemodynamics analyzer. The changing phase of CVDI, the size of brain edema in the traumatic focus and prognosis were compared and analyzed through the combination of CT dynamic observation. Twenty-four normal persons were selected to definite the normal value of CVDI （normal group）. Results Compared with normal group, posttraumatic CVDI in the control group could be divided into 4 phases ： hypoperfusion （ day 0）, hyperpeffusion （days 1 -3）,cerebral vasospasm （days 4 - 14）,intermediary （days 〉 15）. There were 3 phases in the mild therapeutic group ： hypoperfusion （ day 0）, intermediary （ days 1 - 3 ）, recovery （ days 〉 4）, without emerges hyperperfusion and cerebral vasospasm . The volume of brain edema area was the largest postinjury in 14th day for the control group（ 140.9 ± 22.95 ） cm^3 and therapeutic group was （81.72± 15.95 ） cm^3 （ P 〈 0.05）. The rates of consciousness in a week were 22.2% （4/18） in control group and 55.6% （10/18） in therapeutic group （ P 〈 0.05）. After 3 years followup,the rates of unfavorable prognosis were 55.6% （10/18） in control group and 22.2% （4/18） in therapeutic group （P 〈 0.05）. Conclusions Mild hypothermia treatment can improve the prognosis through stabilizing the cerebral circulation especially by inhibiting acute hyperperfusion and improving tardive hypoperfusion after the injury, so then tile volume of cerebral edema in focus is lessened remarkably and the prognosis is improv

关 键 词：颅脑损伤 亚低温疗法 脑缺血再灌注 

分 类 号：R651.1[医药卫生—外科学]