亚低温治疗重型颅脑损伤患者的前瞻性对照研究  

Prospective controlled study of mild hypothermia therapy in the treatment of patients with severe craniocerebral injury

作　　者：都小龙 常建永[1] 孙锋磊 DU Xiaolong;CHANG Jianyong;SUN Fenglei(Weifang People’s Hospital,Weifang 261000,China)

机构地区：[1]潍坊市人民医院,山东潍坊261000

出　　处：《中国实用神经疾病杂志》2024年第11期1337-1341,共5页Chinese Journal of Practical Nervous Diseases

基　　金：潍坊市科技发展计划项目(编号:2022YX058)。

摘　　要：目的前瞻性对照分析亚低温治疗对重型颅脑损伤患者的影响。方法选取83例重型颅脑损伤患者,入院时间2022-01—2023-09。所有患者随机数字表法分为对照组40例(标准大骨瓣减压术治疗)与亚低温组43例(标准大骨瓣减压术+亚低温治疗),评价2组患者治疗前后基本生命体征、血气指标、脑血流指标、神经功能,观察并发症发生率。结果治疗后,2组rSO_(2)、CPP升高,亚低温组高于对照组[(86.24±3.87)mmHg比(79.64±3.48)mmHg,(69.24±4.25)比(62.34±4.31)],ICP均降低,亚低温组低于对照组[(26.18±2.25)mmHg比(31.28±2.28)mmHg],差异均有统计学意义(P<0.05);治疗前后比较,亚低温组体温明显降低[(36.37±0.27)℃比(34.15±0.31)℃,P<0.05],对照组体温无显著变化[(36.45±0.21)℃比(36.56±0.16)℃,P>0.05];2组患者SaO、PaO_(2)水平均明显升高,亚低温组高于对照组[(95.64±2.16)%比(92.31±2.13)%,(86.27±5.10)mmHg比(81.31±5.14)mmHg],PaCO_(2)均下降,亚低温组低于对照组(36.15±3.11)mmHg比(42.72±3.23)mmHg],差异均有统计学意义(P<0.05);2组患者Qm、Vm均升高,亚低温组高于对照组[(15.63±4.38)mL/s比(11.49±3.61)mL/s,(42.67±5.18)cm/s比(38.56±4.26)cm/s],DR均降低,亚低温组低于于对照组[(263.36±22.57)kPa/s比(295.27±26.64)kPa/s],差异均有统计学意义(P<0.05);2组患者GCS评分均升高,亚低温组高于对照组(9.24±1.18)分比(7.56±1.26)分,NIHSS评分降低,亚低温组低于对照组[(22.65±3.39)分比(25.63±3.53)分],6个月后GOS评分亚低温组高于对照组(4.25±0.24)分比(3.85±0.14)分,差异均有统计学意义(P<0.05);2组患者并发症发生率无统计学差异(16.67%比33.33%,P>0.05)。结论重型颅脑损伤患者行基础颅脑手术后联合亚低温辅助治疗能够改善患者脑氧代谢及脑血流,从而促进神经功能恢复,改善预后。Objective To analyze the effect of mild hypothermia therapy in patients with severe craniocerebral injury by prospective controlled study.Methods A total of 83 patients with severe craniocerebral injury were enrolled from January 2022 to September 2023.According to random number table method,they were divided into control group(40 cases,standard large trauma craniotomy)and mild hypothermia group(43 cases,standard large trauma craniotomy+mild hypothermia therapy).The basic vital signs,blood gas indexes,cerebral blood flow indexes and nerve function in the two groups were evaluated before and after treatment.The incidence of complications in the two groups was observed.Results After treatment,rSO_(2) and CPP increased in both groups,which were higher in mild hypothermia group than those in the control group(86.24±3.87 vs 79.64±3.48,69.24±4.25 vs 62.34±4.31),while ICP decreased,which was lower in mild hypothermia group than that in the control group(26.18±2.25 vs 31.28±2.28,P<0.05).After treatment,body temperature significantly decreased in mild hypothermia group(36.37±0.27 vs 34.15±0.31,P<0.05),but there was no significant change in control group(36.45±0.21 vs 36.56±0.16,P>0.05).After treatment,SaO and PaO_(2) significantly increased in both groups,which were higher in mild hypothermia group than those in the control group((95.64±2.16)%vs(92.31±2.13)%,86.27±5.10 vs 81.31±5.14),while PaCO_(2)decreased,which was lower in mild hypothermia group than that in the control group(36.15±3.11 vs 42.72±3.23,P<0.05).After treatment,Qm and Vm increased in both groups,which were higher in mild hypothermia group than those in the control group(15.63±4.38 vs 11.49±3.61,42.67±5.18 vs 38.56±4.26),while DR decreased,which was lower in mild hypothermia group than that in the control group(263.36±22.57 vs 295.27±26.64,P<0.05).After treatment,GCS score increased in both groups,which was higher in mild hypothermia group than that in the control group(9.24±1.18 vs 7.56±1.26),while NIHSS score decreased,which was lo

关 键 词：重型颅脑损伤 标准大骨瓣减压术 亚低温 神经功能 脑氧代谢 脑血流 

分 类 号：R651.15[医药卫生—外科学]