亚低温脑保护对重型创伤性颅脑损伤患者预后的影响  

Impacts of mild hypothermia cerebral protection on prognosis of patients with severe traumatic craniocerebral injury

作　　者：解毅 许传凯 饶璐 XIE Yi;XU Chuankai;RAO Lu(Department of Neurosurgery,Shenzhen Shekou District People's Hospital,Shenzhen518052,China)

机构地区：[1]深圳市南山区蛇口人民医院神经外科,广东深圳518052

出　　处：《中国现代医生》2020年第28期18-21,共4页China Modern Doctor

基　　金：广东省深圳市南山区卫生科技资助项目(2019045)。

摘　　要：目的探讨亚低温脑保护对重型颅脑损伤患者预后的影响。方法选取我院收治的重型创伤性颅脑损伤患者资料(2013年3月~2019年12月),依照治疗方法分为实验组300例和对照组300例。对照组入院后均进行生命体征监护,如呼吸、心率、体温、血压,定期行血常规、血气分析、血电解质、肝肾功能、心肌酶谱、血糖检查等。行脑室外引流监测颅内压,当ICP>15 mmHg时,静脉给予呋塞米、甘露醇。锁骨下静脉穿刺输液维持水、电解质平衡,给予神经营养药物治疗。实验组在对照组基础上给予患者亚低温脑保护。观察、对比两组患者预后良好率、颅内压、血清抗脑抗体浓度及脑血流动力学。结果实验组预后良好率为51.00%,对照组为35.62%,差异有统计学意义(P<0.05);治疗后,两组颅内压降低,实验组各时间点低于对照组(P<0.01);两组血清抗脑抗体浓度均呈上升趋势,实验组整体低于对照组(P<0.01);两组Vs、Vm呈升高趋势,PI指数呈下降趋势;两组Vs各时间点比较,差异均有统计学意义(P<0.01),Vm、PI指数治疗7 d、14 d比较,差异有统计学意义(P<0.01)。结论重型创伤性颅脑损伤患者采用亚低温脑保护治疗,可降低颅内压、血清抗脑抗体含量,增加脑血流量,预后良好。Objective To investigate the impacts of mild hypothermia cerebral protection on prognosis of patients with severe traumatic craniocerebral injury.Methods The data of patients with severe traumatic craniocerebral injury admitted to our hospital from March 2013 to December 2019 were selected and divided into the experimental group(n=300)and the control group(n=300)according to the treatment methods.After admission,the control group was treated with vital signs monitoring,such as respiration,heart rate,body temperature,blood pressure,regular blood routine,blood gas analysis,blood electrolyte,hepatic and renal function,myocardial enzyme spectrum,blood glucose examination,etc.Intracranial pressure was monitored by extra ventricular drainage.When ICP>15 mmHg,furosemide and mannitol were given intravenously.Balance of water and electrolyte were maintained by subclavian vein puncture infusion,and neurotrophic drugs were given.The experimental group was given mild hypothermia cerebral protection on the basis of the control group.Good prognosis rate,intracranial pressure,concentration of serum anti-cerebral antibody and cerebral hemodynamics were observed and compared between the two groups.Results The good prognosis rate of the experimental group was 51.00%,and that of the control group was 35.62%,with statistically significant difference(P<0.05).After treatment,the intracranial pressure in both groups decreased,and it was lower in the experimental group than in the control group at all time points(P<0.01).The concentration of serum anti-cerebral antibody in both groups showed an increasing trend,while the experimental group was lower than the control group integrally(P<0.01).In the two groups,Vs and vm showed an increasing trend,while the PI index showed a decreasing trend.The comparison of Vs at each time point between the two groups was statistically significant(P<0.01),and the Vm and PI indexes at 7 days and 14 days after treatment were statistically significant(P<0.01).Conclusion Mild hypothermia cerebral protection

关 键 词：亚低温 重型创伤性颅脑损伤 预后良好率 颅内压 血清抗脑抗体浓度 脑血流动力学 

分 类 号：R651.15[医药卫生—外科学]