不同时程亚低温治疗对重型颅脑损伤患者免疫功能及预后的影响  

Effect of Different Durations Mild Hypothermia on Immune Function and Prognosis in Patients with Severe Traumatic Brain Injury

作　　者：林洁[1] 曾繁林[2] 刘欣[1] 朱秋平 朱宏泉[1] LIN Jie;ZENG Fanlin;LIU Xin;ZHU Qiuping;ZHU Hongquan(Department of Critical Care Medicine,First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,China;不详)

机构地区：[1]赣南医学院第一附属医院重症医学科,江西赣州341000 [2]赣南医学院第一附属医院肝胆外科,江西赣州341000

出　　处：《中国医学创新》2024年第11期53-57,共5页Medical Innovation of China

基　　金：赣州市指导性科技计划项目(GZ2020ZSF029)。

摘　　要：目的:分析对比不同时程亚低温治疗在重型颅脑损伤(STBI)患者中的效果。方法:选取2020年7月—2023年3月赣南医学院第一附属医院收治的120例STBI患者,按随机数字表法分为三组,各40例。常规组给予脱水、降颅压、去骨瓣减压术基础治疗,对照组在其基础上加以短时程(治疗2 d)亚低温治疗,观察组在常规组基础上加以长时程(治疗5 d)亚低温治疗。对比三组病情严重程度、免疫功能、氧合情况、并发症发生情况及预后。结果:治疗前,三组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、CD4^(+)、CD4^(+)/CD8^(+)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、中心静脉血氧饱和度(ScvO_(2)),动-静脉二氧化碳分压差[P(cv-a)CO_(2)]相比,差异均无统计学意义(P>0.05);治疗后,观察组APACHEⅡ评分、IL-6、TNF-α、IFN-γ、P(cv-a)CO_(2)均低于对照组与常规组,CD4^(+)、CD4^(+)/CD8^(+)、ScvO_(2)均高于对照组与常规组,差异均有统计学意义(P<0.05);观察组、对照组并发症发生率、28 d死亡率均低于常规组,差异均有统计学意义(P<0.05);对照组、观察组并发症发生率、28 d死亡率相比,差异均无统计学意义(P>0.05)。结论:长时程亚低温治疗STBI患者效果更佳,可有效控制病情,改善其免疫功能,且并发症发生率与28 d死亡率更低,改善患者预后。Objective:To analyze and compare the effectiveness of different durations mild hypothermia in the treatment of patients with severe traumatic brain injury(STBI).Method:A total of 120 patients with STBI admitted to First Affiliated Hospital of Gannan Medical College from July 2020 to March 2023 were selected,and divided into three groups by random number table method,with 40 patients in each group.The conventional group received basic treatment of dehydration,intracranial pressure reduction,and decompressive craniectomy,while the control group received short-term(2 d treatment)mild hypothermia treatment,the observation group received long-term(5 d treatment)mild hypothermia treatment on the basis of the conventional group.The severity of the condition,immune function,oxygenation status,occurrence of complications and prognosis among the three groups were compared.Result:Before treatment,acute physiological and chronic health evaluation Ⅱ(APACHEⅡ)scores,CD4^(+),CD4^(+)/CD8^(+),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),central venous oxygen saturation(ScvO_(2)),arterial venous carbon dioxide partial pressure difference[P(cv-a)CO_(2)]of the three groups were cpmpared,the differences were not statistically significant(P>0.05);after treatment,APACHEⅡscore,IL-6,TNF-α,IFN-γ and P(cv-a)CO_(2) in the observation group were lower than those in the control group and the conventional group,while CD4^(+),CD4^(+)/CD8^(+),ScvO_(2) were higher than those in the control group and the conventional group,the differences were statistically significant(P<0.05).The incidence of complications and 28 d mortality rate in the observation group and control group were lower than those in the conventional group,the differences were statistically significant(P<0.05).There were no statistically significant differences in the incidence of complications and 28 d mortality between the control group and the observation group(P>0.05).Conclusion:Longterm mild hypothermia treatment has a better effect on ST

关 键 词：重型颅脑损伤 亚低温 免疫功能 

分 类 号：R651.15[医药卫生—外科学]