静脉灌注法降温与降温毯体表降温对重型弥漫性轴索损伤患者效果比较  

Compare the effect of intravenous vascular perfusion cooling and cooling blankets in patients with severe diffuse axonal injury

作　　者：吕建森[1] 沈婷[1] 吴立峰[1] 

机构地区：[1]浙江省余姚市人民医院,余姚315400

出　　处：《浙江创伤外科》2015年第5期847-848,856,共3页Zhejiang Journal of Traumatic Surgery

摘　　要：目的比较采用静脉灌注法血管内降温与降温毯体表降温达到亚低温治疗对重型弥漫性轴索损伤(DAI)患者凝血功能、内环境及预后的影响。方法前瞻性研究,35例符合入选标准的重型DAI患者,随机分为血管内降温组和降温毯组。分别比较两组患者达到亚低温目标温度的时间和治疗期间凝血功能障碍及内环境紊乱发生率,按照格拉斯哥转归量表进行预后评估。结果血管内降温组达到目标温度时间显著短于降温毯组,肌颤发生率更低;两组凝血功能障碍发生率、低血钾发生率、28天死亡率及预后改善无统计学差异。结论采用血管内降温与降温毯体表降温达到亚低温治疗对重型DAI患者凝血功能、内环境及预后影响无统计学差异,血管内降温达到目标温度时间更短,肌颤发生率低且轻微。Objective To compare the effect of two mild hypothermia therapy, cooling by intravenous vascular perfusion and cooling blankets, in patients with severe diffuse axonal injury （DAI）. Methods 35 patients adapted the criteria of severe DAI were included. All patients were randomly divided into group of intravenous vascular perfusion cooling and the group of cooling blanket. All patients were investigated from the admission of intensive care unit to hospital discharge or death. In two groups of patients, the duration of reaching target temperature （35℃）, the incidence rate of coagulopathy and internal environment disorder were recorded. Glasgow Scale was used for the evaluation of prognostic outcome. Results Age, gender, pretreatment GCS score, APACHEⅡscore had no statistically different in the two groups. The duration of reaching target temperature（35℃） in the group of intravenous vascular perfusion cooling was significantly shorter than in cooling blanket group, which had the lower incidence rate of muscle trembling. There were no significant difference in coagulopathy incidence and the incidence of hypokalemia. 28 days mortality and the prognosis also had no significant difference. Conclusion There were no significant difference in coagulation, internal environment and prognosis by using the two different mild hypothermia therapy, but intravenous vascular perfusion cooling could reach mild hypothermia more quickly, and had low incidence of muscle trembling.

关 键 词：亚低温 弥漫性轴索损伤 

分 类 号：R651.1[医药卫生—外科学]