低温治疗急性大脑半球大面积脑梗死的临床随机对照研究  

Therapeutic hypothermia in patients with acute large hemispheric infarction： a randomized controlled clinical trial

作　　者：梁可可[1] 赵建华[1] 姚勇[1] 姜晓峰[1] 陈云霞[1] 

机构地区：[1]河南省人民医院神经内科,郑州450003

出　　处：《中华神经科杂志》2018年第1期34-38,共5页Chinese Journal of Neurology

摘　　要：目的观察低温治疗对急性大脑半球大面积脑梗死的疗效。方法收集2015年2月至2016年7月于我院住院治疗的73例急性大脑半球大面积脑梗死患者（发病时间在24h内）作为研究对象，采用区组随机化分组的方法将其随机纳入低温治疗组（37例）和对照组（36例），两组患者均予以常规药物治疗，低温治疗组在常规药物治疗的基础上采用ZLJ-2000型颅脑降温抢救（监护）综合治疗仪进行全身体表低温治疗，使其直肠温度控制在32～35℃，持续降温时间5—7d；对照组对于出现高热的患者采用物理降温及药物治疗，保持其直肠温度在正常范围内。观察患者治疗后3个H时改良Rankin量表（mRS）评分，对两组患者的疗效进行评定。结果随访3个月，存活患者中低温治疗组预后良好者（9／17）多于对照组（5／19），但组间差异无统计学意义（x2=2．676，P〉0．05）；低温治疗组患者的病死率[20／37（54．1％）]与对照组[17／36（47．2％）]相比，差异无统计学意义（X2=0．34l，P〉0．05）。结论低温治疗急性大脑半球大面积脑梗死患者安全可行，但并不能明显降低病死率、改善患者的神经功能预后。Objective To investigate the clinical effects of therapeutic hypothermia on the mortality and neurological function recovery in patients with acute large hemispheric infarctiou （LHI）. Methods Seventy-three acute LHI patients （within 24 hours of symptom onset） admitted to our hospital from Februal7 2015 to July 2016 were randomized to the hypothermia group （37 patients）and the control group （36 patients）. Patients in the hypothermia group were given standard medical treatment and the surface cooling with a target temperature between 32 - 35℃ lasting for 5 - 7 days. Patients in the control group were given standard medical treatment and maintained a target temperature of normothermia. All patients were observed the primary end points including mortality and the modified Rankin Scale （mRS） seore at 3 months. Results At three months, nine patients of survivors in the hypothermia group had good outcome （ mRS score 0 - 3）, whereas only five patients of survivors in the control group, though there was no significant difference （9/17 vs 5/19, X2 = 2. 676, P 〉 0. 05 ） between the two groups. Twenty patients （54.1%）died in the hypothermia group , while 17 patients （47. 2% ） in the control group（ X2 = 0. 341, P 〉 0. 05 ）. Conclusion Therapeutic hypothermia is safe and feasible to patients with acute LHI, but may neither reduce mortality nor imorove the neurological outcome in survivors.

关 键 词：低温 卒中 大脑梗塞 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]