应用低温静脉输液专用装置行血管内降温与传统体表降温方法在重型颅脑损伤患者治疗中的对比研究  

Comparison of endovascular hypothermia through hypothermic intravenous infusion device and conventional surface cooling in the treatment of patients with severe craniocerehral injury

作　　者：黄国敏[1] 马明远[1] 张云海[1] 区智凤[1] 胡惠娟[1] 赖慧晶[1] 冼凤仪 

机构地区：[1]广东省佛山市中医院重症医学科,528000

出　　处：《中国实用护理杂志》2017年第6期401-405,共5页Chinese Journal of Practical Nursing

基　　金：2013年建设中医药强省立项资助科研课题（20131058）;2015年佛山市科技计划项目（2015AG10001）

摘　　要：目的 观察应用低温静脉输液专用装置行血管内降温与传统体表降温方法在重型颅脑损伤患者临床治疗中的疗效及安全性.方法 66例重型颅脑损伤患者按随机信封法分为观察组和对照组,每组33例,对照组采取体表降温方法,观察组在体表降温基础上配合低温静脉输液专用装置,目标体温35℃,降温持续时间3~5 d,复温采取自然复温法,控制复温0.1~0.5℃/h,复温至36.0~37.3℃.比较2组患者达到目标体温的时间、维持目标体温过程的稳定性、寒战发生率及严重程度、心律失常发生率、皮肤损伤发生率、躁动发生率,比较2组治疗72 h后的心率、呼吸、脉搏、血压以及格拉斯哥昏迷量表（GCS）评分,比较2组患者治疗30 d后的格拉斯哥预后量表评分及护士工作量.结果 观察组降温速度、达目标体温时间、维持目标体温过程的稳定性分别为（1.3±0.2）℃/h、（2.3±0.2）h、（6.5±1.8）%,对照组分别为（0.5±0.1）℃/h、（3.6±0.6）h、（11.3±2.2）%,2组比较差异有统计学意义（t=1.862、2.112、2.408,P〈0.05）.观察组寒战、心律失常、皮肤损伤及躁动发生率分别为33.33%（11/33）、9.09%（3/33）、6.06%（2/33）、27.27%（9/33）,对照组分别为84.85%（28/33）、15.15%（5/33）、33.33%（11/33）、54.55%（18/33）,2组比较差异有统计学意义（χ2=1.764~2.733,P〈0.05）.观察组治疗72 h后心率、呼吸频率、收缩压、体温、GCS评分分别为（68.31±3.73）次/min、（16.60±1.52）次/min、（136.35±3.71）mmHg（1 mmHg=0.133 kPa）、（34.61±1.05）℃、（9.91±4.05）分,对照组分别为（58.31±3.62）次/min、（19.81±1.83）次/min、（150.66±2.70）mmHg、（35.65±1.36）℃、（7.63±3.17）分,2组比较差异有统计学意义（t=2.275~3.035,P〈0.05）.观察组更换冰块时间及翻身时间分别为（14.03±3.11）、（15.08±3.07）min/h,对照组分别为（38.12±2.70）、（26.16±2.54）min/h,2组比较�Objective To observe the effect and safety of the endovascular hypothermia through hypothermic intravenous infusion device in the treatment of patients with severe craniocerebral injury compared with conventional surface cooling. Methods A total of 66 cases of patients with severe cranio-cerebral injury were randomly divided into the observation group and the control group with 33 cases in each group according to envelop randomization. The control group received surface cooling, and the observation group was given surface cooling plus endovascular hypothermia through hypothermic intravenous infusion device. The target temperature was 35 ℃maintained for 3-5 days, and natural rewarming was applied at the speed of 0.1-0.5℃/h to 36.0-37.3℃. The time to reach target temperature, the constant stability, the incidence rate and severity of complication such as shiver, arrhythmia, skin injury and agitation were recorded and compared between two groups, as well as the heart rate, breathing rate, pulse rate, blood pressure and Glasgow Coma Scale （GCS） scores after 72 h of treatment. Glasgow Outcome Scale scores 30 days after treatment and nursing workload were also calculated and compared. Results The cooling speed, time to reach target temperature and the ability to maintain at 35℃were （1.3±0.2）℃/h, （2.3±0.2） h and （6.5± 1.8）%in the observation group, respectively, compared with （0.5±0.1）℃/h, （3.6±0.6） h and （11.3±2.2）%in the control group, which had significant differences （t=1.862, 2.112, 2.408,P 〈 0.05）. The occurrence rates of shiver, arrhythmia, skin damage and dysphoria and restlessness in the observation group were 33.33%（11/33）, 9.09%（3/33）, 6.06%（2/33） and 27.27%（9/33）, respectively, which were much lower than those in the control group 84.85%（28/33）, 15.15%（5/33）, 33.33%（11/33）, 54.55%（18/33）,χ2=1.764-2.733,P〈0.05. The heart rate, breathing rate, pulse rate, systolic blood pressure and GCS score after 72 h of treatment were（6

关 键 词：颅脑损伤 低温静脉输液专用装置 血管内降温 

分 类 号：R473.6[医药卫生—护理学]