亚低温治疗重型颅脑损伤后脑血管痉挛的疗效观察  

Effect of mild hypothermia on the cerebral vasospasm after severe traumatic brain injury

作　　者：夏永勤[1] 严丽丽[1] 刘绍明[1] 徐如祥[2] 王向宇[2] 

机构地区：[1]兰州军区乌鲁木齐总医院神经外科,乌鲁木齐市830000 [2]第一军医大学珠江医院全军神经医学研究所

出　　处：《中华实用诊断与治疗杂志》2009年第12期1161-1163,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：中国人民解放军兰州军区医药卫生科研基金资助项目(LHX-2007010);全军临床医学中青年人才培养基金资助项目(9701)

摘　　要：目的:探讨亚低温对重型颅脑损伤后脑血管痉挛的影响。方法:36例重型颅脑损伤患者(GCS≤8分)随机分为对照组和治疗组各18例。用脑循环动力检测仪检测伤后0,1,3,7,14,21d的脑循环动力学参数。对照组维持正常体温,治疗组4～8h将肛温降至33℃左右,维持3～5d。分析比较2组脑循环动力学参数变化规律和预后不良(GOS<3分)率。同期选择24例正常人检测其脑循环动力学参数,作为正常组。结果:(1)与正常组比较,对照组伤后脑循环动力学参数可划分为4个期,而治疗组仅表现出3个期。对照组和治疗组脑循环动力学参数出现脑血管痉挛变化分别为8例(44.4%)和2例(11.1%),2组比较差异有统计学意义(P<0.05),初步得出脑循环动力学参数诊断外伤性脑血管痉挛的参考值。(2)随防3个月时,对照组预后不良率为61.1%(11/18),治疗组为33.3%(6/18),2组比较差异无统计学意义(P>0.05);随防3年后,对照组预后不良率为55.6%(10/18),治疗组为22.2%(4/18),2组比较差异有统计学意义(P<0.05)。结论:亚低温通过稳定重型颅脑损伤后脑循环功能,减少脑血管痉挛发生率,从而改善远期预后。Objective To investigate the effect of mild hypothermia on cerebral vasospasm after severe traumatic brain injury and its clinical significance.Methods Thirty-six patients with severe traumatic brain injury （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 group.The cerebrovascular hemodynamic index was measured 0,1,3,7,10,14,21 days after severe traumatic brain injury with the cerebrovascular hemodynamics analyzer.The changing phase of cerebrovascular hemodynamic index and prognosis were compared and analyzed.Twenty-four normal persons were selected as normal group and measured the normal value of cerebrovascular hemodynamic index.Results Compared with normal group,post-traumatic index in the control group was divided into 4 phases.There were three phases in the mild hypothermia therapeutic group.There were 8 cases and 2 cases of cerebral vasospasm in control and the therapy group respectively（P〈0.05）.According to clinic trial,the elementary reference value of index was obtained for diagnosing the traumatic.At 3 months follow-up,the rates of unfavorable prognosis were 61.1% （11/18 cases） in control group and 33.3% （6/18 cases） in therapeutic group （P〉0.05）.After 3 years follow-up,the rates of unfavorable prognosis were 55.6% （10/18 cases） in control group and 22.2% （4/18 cases） in therapeutic group（P〈0.05）.Conclusion Mild hypothermia treatment can reduces incidence of cerebral vasospasm by stabilizing cerebral circulation after severe traumatic brain injury,so that the future prognosis is improved.

关 键 词：重型颅脑损伤 亚低温 脑血管痉挛 脑循环 预后 

分 类 号：R651.15[医药卫生—外科学]