轻度低温对重度创伤性脑损伤的治疗作用。

Therapeutic effect of mild hypothermia on severe traumatic head injury.

作者信息

Qiu Wu-si, Liu Wei-guo, Shen Hong, Wang Wei-min, Hang Zhi-Liang, Zhang Ying, Jiang Su-jun, Yang Xiao-feng

机构信息

Department of Neurosurgery, Second Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310009, China.

出版信息

Chin J Traumatol. 2005 Feb;8(1):27-32.

PMID:15676086

Abstract

OBJECTIVE

To investigate the therapeutic effect of mild hypothermia on severe traumatic brain injury.

METHODS

Eighty-six in-patients with severe traumatic brain injury treated ordinarily were consecutively randomized into two groups: a hypothermia group (n=43) and a normothermia group (the control group, n=43). In the hypothermia group, the core temperature (i.e., nasopharyngeal or brain temperature) of the patient was reduced to and maintained at 33-35 degrees C with a systemic cooling blanket. Natural rewarming began after 3-5 days (mean: 4.3 days) of hypothermia treatment. In the control group, the patient received no hypothermia treatment. The vital sign, extradural pressure and serum superoxide dismutase were observed and measured during treatment, and the complications as well as the Glasgow outcome scale were evaluated at 2 years after injury.

RESULTS

The mean extradural pressure in the hypothermia group (27.38 mm Hg +/- 4.88 mm Hg at 24 hours, 29.40 mm Hg +/- 4.50 mm Hg at 48 hours and 26.40 mm Hg +/- 4.13 mm Hg at 72 hours after injury) was much lower than that in the control group (32.63 mm Hg +/- 3.00 mm Hg, 34.80 mm Hg +/- 6.00 mm Hg and 31.81 mm Hg +/- 4.50 mm Hg respectively at 24, 48 and 72 hours, P<0.05). The mean serum superoxide dismutase levels in the hypothermia group on days 3 and 7 (583.7 microg/L +/- 99.6 microg/L and 699.4 microg/L +/- 217.3 microg/L, respectively) were much higher than those in the control group at the same time period (446.6 microg/L +/- 79.5 microg/L and 497.1 microg/L +/- 101.2 microg/L, respectively, P<0.01). The recovery rates at 2 years after injury were 65.1% in the hypothermia group and 37.2% in the control group (P<0.05). The mortality rates were 25.6% in the hypothermia group and 51.2% in the control group (P<0.05). The complications, including pulmonary infections, thrombocytopenia (platelet count < 100 x 10(9)/L), hemorrhage in the digestive tract, electrolyte disorders and renal malfunction, were managed without severe sequelae.

CONCLUSIONS

Mild hypothermia is a safe and effective therapeutic method, which can lower the extradural pressure, increase the serum superoxide dismutase and improve the neurological outcomes without severe complications in the patients with severe traumatic brain injury.

摘要

目的

探讨亚低温对重型颅脑损伤的治疗效果。

方法

将86例常规治疗的重型颅脑损伤住院患者连续随机分为两组：亚低温组（n = 43）和常温组（对照组，n = 43）。亚低温组患者使用全身降温毯将核心温度（即鼻咽温度或脑温）降至并维持在33 - 35℃。亚低温治疗3 - 5天（平均4.3天）后开始自然复温。对照组患者不进行亚低温治疗。治疗期间观察并测量生命体征、硬膜外压力和血清超氧化物歧化酶，伤后2年评估并发症及格拉斯哥预后评分。

结果

亚低温组伤后24小时、48小时和72小时的平均硬膜外压力（分别为27.38 mmHg±4.88 mmHg、29.40 mmHg±4.50 mmHg和26.40 mmHg±4.13 mmHg）明显低于对照组（24小时、48小时和72小时分别为32.63 mmHg±3.00 mmHg、34.80 mmHg±6.00 mmHg和31.81 mmHg±4.50 mmHg，P<0.05）。亚低温组第3天和第7天的平均血清超氧化物歧化酶水平（分别为583.7 μg/L±99.6 μg/L和699.4 μg/L±217.3 μg/L）明显高于同期对照组（分别为446.6 μg/L±79.5 μg/L和497.1 μg/L±101.2 μg/L，P<0.01）。伤后2年亚低温组的恢复率为65.1%，对照组为37.2%（P<0.05）。亚低温组死亡率为25.6%，对照组为51.2%（P<0.05）。包括肺部感染、血小板减少（血小板计数<100×10⁹/L）、消化道出血、电解质紊乱和肾功能不全在内的并发症均未导致严重后遗症。