头颈部体表亚低温对危重型颅脑损伤患者神经元特异性烯醇化酶、谷氨酸及预后的影响  

Effects of head and neck cooling on NSE,glutamic acid in blood and prognosis of patients with critical traumatic brain injury

作　　者：冯伟生 刁井地 侯思南 徐继来 张宜波[3] 刘爽 王红 丰广魁 FENG Weisheng;DIAO Jingdi;HOU Sinan;XU Jilai;ZHANG Yibo;LIU Shuang;WANG Hong;FENG Guangkui(Department of Emergency,Lianyungang Hospital of Traditional Chinese Medicine,Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine,Lianyungang 222000,China;不详)

机构地区：[1]南京中医药大学连云港附属医院(连云港市中医院)急诊医学科,江苏连云港222000 [2]连云港市市立东方医院,江苏连云港222042 [3]连云港市赣榆区人民医院急诊医学科,江苏连云港222100

出　　处：《实用医学杂志》2021年第17期2233-2237,共5页The Journal of Practical Medicine

基　　金：南京医科大学江苏康达医药卫生发展研究院科研项目(编号:NYKDKJ2015015);江苏省连云港市临床重点专科建设项目(编号:2020-35)。

摘　　要：目的观察头颈部体表亚低温(HNC)对危重型颅脑损伤(cTBI)患者神经元特异性烯醇化酶(NSE)、谷氨酸及预后的影响。方法前瞻性分析2016年12月到2020年10月入住3个医院ICU cTBI患者81例,按随机数表分入头颈联合降温组(HNC组41例)和传统冰帽组(HC组40例),在到达医院、入院24 h及72 h检测血NSE和谷氨酸浓度(Glu),全程监测格拉斯哥评分、耳蜗温度、凝血功能、血压、心率变化及寒战反应和28 d病死率,随访6个月格拉斯哥预后评分(GOS),根据28 d预后将患者分为死亡和存活亚组。结果HNC 72 h NSE(56.8±34.0)ng/mL比24 h下降(12.45±18.16)ng/mL,差异具有统计学意义(t=4.390,P<0.01),显著高于HC组[(-2.18±21.45)ng/mL,(t=3.315,P<0.01)];HNC 24 h血Glu(185.8±42.7)μmol/L显著高于HC组[(158.0±43.1)μmol/L,(t=2.916,P<0.01)],72 h Glu(160.6±21.3)μmol/L出现显著降低(t=4.951,P<0.01),亦显著低于HC组[(177.3±43.2)μmol/L,(t=2.190,P<0.05)];28 d病死率[31.7%vs.32.5%,(χ^(2)=0.006,P>0.05)]两组差异无统计学意义;存活者出院时GCS[(7.82±1.86)vs.(8.00±2.60),(t=0.293,P>0.05)]差异亦无统计学意义;HNC组6个月GOS评分预后良好比例明显优于HC组(41.5%vs.20.5%,χ^(2)=4.083,P<0.05),不良反应两组间差异无统计学意义。存活亚组中NSE和Glu表现更加显著;死亡亚组NSE差异无统计学意义,HNC组72 h Glu仍显著降低。结论HNC治疗72 h可以显著降低cTBI患者血NSE浓度,Glu浓度短暂起伏后亦得到显著控制,并能显著改善患者远期预后。Objective To evaluate the effect of head and neck cooling(HNC)on neuron-specific enolase(NSE),glutamic acid(Glu)in blood and its influence on the prognosis of patients with critical traumatic brain injury(cTBI).Methods A prospective study on 81 patients with cTBI admitted to our three intensive care units from December 2016 to October 2020,and be randomly divided into head and neck cooling group(HNC group 41)and normal ice cap cooling group(HC group 40).At admission,24 and 72 hours after admission,venous blood was taken to detect the concentration of NSE and Glu.Glasgow Coma Scale(GCS)Score,cochlear temperature,coagulation function,blood pressure,heart rate,shivering,and 28-day case fatality were monitored.At 6 months after injury,the Glasgow outcome scale(GOS)was used to assess the clinical outcome.Patients were divided into death and survival subgroups according to the 28-day prognosis.Results HNC for 72 hours,the concentration of NSE(56.8±34.0)ng/mL was significantly lower(t=4.390,P<0.01)than the 24 hour′s of itself,be decreased by(12.45±18.16)ng/mL,which was significantly higher(t=3.315,P<0.01)than that of ice cap group(-2.18±21.45)ng/mL;In HNC group,24 h concentration of Glu[(185.8±42.7)μmol/L]was significantly higher(t=2.916,P<0.01)than that of ice cap group(158.0±43.1)μmol/L.72 h Glu(160.6±21.3)μmol/L showed a significant decrease(t=4.951,P<0.01)to the 24 hour′s of itself,which also significantly lower than that of the ice cap group[(177.3±43.2)μmol/L,t=2.190,P<0.05].There was no significant difference in 28-day mortality(31.7%vs.32.5%,χ^(2)=0.006,P>0.05)between the two groups.Compare to the ice cap group,there wasn′t a difference be found in GCS scores[(7.82±1.86)vs.(8.00±2.60),t=0.293,P>0.05]at discharge.But at 6 months after injury,the GOS of the HNC group be significantly improved(41.5%vs.20.5%,χ^(2)=4.083,P<0.05)to the HC group,and there was no significant difference in adverse reactions between the two groups.In the survival subgroup,NSE and Glu showed a more remarkable performan

关 键 词：低温 人工 颅脑损伤 谷氨酸 磷酸丙酮酸水合酶 

分 类 号：R651.15[医药卫生—外科学]