规范化实施亚低温疗法的临床应用研究  

Clinical application of standardized subhypothermia therapy

作　　者：秦义民 朗淑杰 马承君 王学义[1] 马哲[1] 王栓宏[1] 

机构地区：[1]内蒙古通辽市医院西院综合外科,028000

出　　处：《中国临床研究》2011年第10期886-888,共3页Chinese Journal of Clinical Research

摘　　要：目的分析冰盐水联合冰帽与冰毯的亚低温疗法对重症脑卒中和颅脑外伤患者的临床疗效及神经功能的恢复作用,为规范化实施亚低温疗法提供可靠的临床资料。方法收集重症脑卒中和颅脑损伤(GCS≤8分)患者84例,按入院时间先后分为对照组和观察组,每组42例。2组均给予保持呼吸道通畅、预防感染、脱水、降低颅内压以及胞二磷胆碱、脑复康、神经节苷脂钠等常规治疗,对照组采用联合冰帽和冰毯的亚低温疗法,观察组采用冰盐水联合冰帽和冰毯的亚低温疗法。对患者入院时和6个月时的神经系统分别进行GCS评分与GOS评分,并对治疗12个月后的生活质量采用KPS评分进行评估。结果发病至开始亚低温治疗的时间及开始实施亚低温至目标低温的时间,观察组为(8±4)h和(3±1)h,对照组为(16±5)h和(6±2)h,2组比较差异均有统计学意义(P均<0.05)。观察组和对照组患者6个月时的GOS评分分别是7.01±1.12和4.02±1.06,观察组明显优于对照组(P<0.05);治疗12个月后评估生活质量(KPS评分),观察组的远期生活质量明显优于对照组(P<0.05)。结论对重症脑卒中和颅脑外伤患者采用冰盐水联合冰帽和冰毯的亚低温疗法,较采用单纯冰帽与冰毯的亚低温疗法,具有更好的脑保护作用。Objective To investigate the clinical therapeutic effect of subhypothermia treatment with cold physiologic saline combined with ice cap and blanket for severe cerebral apoplexy and craniocerebral trauma and the recovery effect on nervous function,in order to provide standardized and reliable clinical data for clinical application of subhypothermia.Methods Eighty-four patients with severe cerebral apoplexy and craniocerebral trauma whose Glasgow coma scale（GCS）score≤8 were divided into control group and observation group（n=42 each） according to the admission date.On the basis of conventional treatment such as opening airway,lowering intracranial pressure,preventing infection,dehydration and the use of nicholin,piracetam and ganglioside,subhypothermia treatment with ice cap and blanket was applied in control group,while ice cap and blanket,combined with intravenous infusion of cold physiologic saline was used in observation group.The nervous function at admission and at 6th month was respectively evaluated with GCS and Glasgow outcome scale（GOS）,and life quality of 12 months after treatment was assessed with Kamofsky Scale（KPS）.Results For the observation group,the time from onset to starting subhypothermia treatment and the time from starting hypothermia treatment to reaching temperature of target hypothermia were（8±4） h and（3±1） h,respectively,which were significant shorter than（16±5）h and（6±2）h of the contronl group（all P0.05）.GOS score at 6th month in observation group was better than that in control group（7.01±1.12 vs 4.02 ±1.06,P0.05）.The life quality assessment（KPS score） after 12 months showed that the long-term life quality in observation group was better than that in control group（P0.05）.Conclusions Subhypothermia treatment with cold physiologic saline combined with ice cap and blanket has more advantages of brain protection compared with subhypothermia treatment with ice cap and blanket only for severe cerebral apoplexy and craniocerebral trauma.

关 键 词：脑卒中 重症 颅脑外伤 冰盐水 亚低温 预后 

分 类 号：R454.5[医药卫生—治疗学]