血管内低温治疗对重型颅脑损伤标准大骨瓣减压术后患者颅内压及脑血流动力学的影响  

Effects of intravascular hypothermia on intracranial pressure and cerebral hemodynamics in patients with severe traumatic brain injury after standard decompression craniectomy

作　　者：高英 廖利萍[2] 何琦[2] 陈鹏 王科 陈英[2] 邓永兵[2] 牟绍玉[1] GAO Ying;LIAO Liping;HE Qi;CHEN Peng;WANG Ke;CHEN Ying;DENG Yongbing;MU Shaoyu(School of Nursing,Chongqing Medical University,Chongqing,400016;Department of Neurosurgery,Chongqing Emergency Medical Center,Chongqing,400014,China)

机构地区：[1]重庆医科大学护理学院,重庆400016 [2]重庆市急救医疗中心神经外科,重庆400014

出　　处：《陆军军医大学学报》2022年第13期1307-1313,共7页Journal of Army Medical University

基　　金：重庆市科卫联合医学科研项目(2022MSXM111)。

摘　　要：目的探讨血管内低温治疗对重型颅脑损伤(severe traumatic brain injury,sTBI)标准大骨瓣减压术后患者颅内压及脑血流动力学的影响。方法采用回顾性队列研究,收集2019年1月至2021年3月在重庆市急救医疗中心接受标准大骨瓣减压术后颅内压(intracranial pressure,ICP)>20 mmHg的82例重型颅脑损伤患者临床资料,根据术后是否实施血管内低温治疗分组,分析血管内低温治疗对两组患者ICP、脑血流动力学水平、脑损伤标志物含量等差异的影响,采用格拉斯哥预后评分描述预后。结果共82例患者纳入研究,其中实施低温治疗38例为实验组,未实施低温治疗44例为对照组。实验组实施低温治疗后ICP开始下降,于12 h后降至20 mmHg以下;对照组术后ICP波动幅度大,于18 h后ICP降至20 mmHg以下。术后22、24 h,实验组ICP较对照组降低更明显(P<0.05);术后1周脑血流动力学水平:两组大脑中动脉收缩期峰值血流速度、平均血流速度均较术前上升,实验组较对照组上升更明显(P<0.05);两组搏动指数均较术前降低,实验组较对照组降低更明显(P<0.05);术后1周脑损伤标志物含量:两组角质纤维酸性蛋白、S-100β蛋白、神经元特异性烯醇化酶均较治疗前降低,且实验组降低更明显(P<0.05);术后6个月实验组预后良好22例(57.90%),对照组预后良好15例(34.09%),两组比较差异有统计学意义(P=0.042)。结论血管内低温治疗可降低sTBI标准大骨瓣减压术后患者ICP,改善脑血流动力学。ObjectiveTo investigate the effects of intravascular hypothermia on intracranial pressure(ICP)and cerebral hemodynamics in patients with severe traumatic brain injury(sTBI)after standard decompression craniectomy.MethodsA retrospective cohort study was carried out on 82 sTBI patients admitted to Chongqing Emergency Medical Center from January 2019 to March 2021.All patients received standard decompressive craniectomy(ICP>20 mmHg).Among them,38 patients were treated with intravascular hypothermia as the experimental group,and 44 patients were not as the control group.The effects of intravascular hypothermia on ICP,cerebral hemodynamics,and brain injury markers were analyzed,and the results were compared between the 2 groups.Glasgow coma scale was used to evaluate the prognosis.ResultsICP in the experimental group began to decrease after hypothermia treatment,and decreased to less than 20 mmHg in 12 h later.In the control group,ICP fluctuated greatly,and decreased to below 20 mmHg in 18 h later.At 22 and 24 h after operation,ICP was more significantly decreased in the experimental group than the control group(P<0.05).At 1 week after operation,the peak systolic blood flow velocity and average blood flow velocity of middle cerebral artery were increased,the pulsatile index was decreased,the serum contents of glial fibrillary acidic protein,S-100βand neuron-specific enolase were decreased in the 2 groups.And above changes were more obviously in the experimental group than the control group(all P<0.05).In 6 months after operation,22 cases(57.90%)in the experimental group and 15 cases(34.09%)in the control group achieved a good prognosis,with significant difference between them(P=0.042).ConclusionIntravascular hypothermia can reduce ICP and improve cerebral hemodynamics in sTBI patients after standard decompression craniectomy.

关 键 词：重型颅脑创伤 标准大骨瓣减压术 血管内低温治疗 颅内压 脑血流动力学 

分 类 号：R454.5[医药卫生—治疗学] R619[医药卫生—临床医学] R651.15