亚低温治疗重型颅脑损伤的效果观察  

Therapeutic Effect of Mild Hypothermia on Patients with Severe Traumatic Brain Injury

作　　者：夏永勤[1] 严丽丽[1] 刘绍明[1] 徐如祥[2] 王向宇[3] 

机构地区：[1]兰州军区乌鲁木齐总医院神经外科,新疆乌鲁木齐830000 [2]北京军区总医院神经外科,北京100700 [3]珠江医院神经外科,广东广州510282

出　　处：《中国临床神经外科杂志》2009年第12期725-727,共3页Chinese Journal of Clinical Neurosurgery

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(批号:9701)

摘　　要：目的观察亚低温对重型颅脑损伤（sTBI）患者的治疗效果。方法36例sTBI患者（Gcs≤8分）随机分为对照组和亚低温组，每组18例。伤后0、1、3、7、14、21d各行一次头颅CT检查，手术后病人均持续监测颅内压7d。对照组维持正常体温，亚低温组人院后在4．8h内将肛温降至33℃左右，并维持3～5d。比较两组颅内压、伤灶脑水肿体积变化和预后不良（GOS〈3分）率。结果在伤后第7天，对照组和亚低温组颅内压分别为（3．15±0．24）kPa和（1．78±0．24）kPa；在伤后第14天，对照组和亚低温组伤灶脑水肿体积分别为（140．90±22．95）cm^3和（81．72±15．95）cm^3；伤后1周内患者清醒率对照组和亚低温组分别为22．2％（4／18）和55．6％（10／18）；伤后3年随防时，预后不良率对照组为55．6％（10／18），亚低温组为22．2％（4／18）。上述指标两组比较均相差显著（P〈0．05）。结论亚低温治疗法能减轻颅脑损伤患者的脑水肿，稳定其颅内压、缩短其昏迷时间，从而改善其远期预后。Objective To observe the curative effect of mild hypothermia on the patients with severe traumatic brain injury （sTBI）. Methods Thirty-six patients with sTBI （GCS≤8） were randomly divided into both the conventional treatment （control） and mild hypothermia （treatment） groups of 18 patients each. The volume of brain edema was measured by CT day 0, 1, 3, 7, 14 and 21 respectively after sTBI. Intracranial pressure （ICP） in all the patients after the operation was continuously monitored for 7 days. The rectal temperature of 33℃ was maintained from 3 to 5 days in the treatment group. The volume of brain edema in the injured loci, ICP and the clinical outcome were compared between both the control and treatment groups. Results ICPs in the control and treatment groups were （3.15±0.24） kPa and （1.78±0.24） kPa respectively day 7 after sTBI. The volumes of brain edema in the control and treatment groups were （140.9±22.95）cm^3 and （81.72±15.95）cm^3 respectively day 14 after sTBI. The rates of consciousness recovery within a week in the control group and treatment group were 22.2% （4/18） and 55.6% （10/18） respectively. The rates of unfavorable prognosis in the control group and treatment group were 55.6% （10/18 cases） and 22.2% （4/18 cases） respectively 3 years after sTBI. There were significantly differences in the above-mentioned ICPs, volumes of brain edema, rates of consciousness recovery and rates of unfavorable prognosis between both the group （P〈0.05）. Conclusion Mild hypothermia treatment can improve the future prognosis through alleviating brain edema and decreasing ICP after sTBI in the patients with sTBI.

关 键 词：重型颅脑损伤 亚低温 脑水肿 颅内压 预后 

分 类 号：R739.45[医药卫生—肿瘤] R651.11[医药卫生—临床医学]