Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
J Neurotrauma. 2009 Nov;26(11):1905-9. doi: 10.1089/neu.2008.0828.
This study investigated the safety and neuroprotective effect of moderate hypothermia in children with severe traumatic brain injury (TBI). Twenty-two children suffering from TBI were randomly divided into groups treated with moderate hypothermia (intracranial temperature of 34.5 +/- 0.2 degrees C, maintained for 72 h, n = 12) or normothermia (intracranial temperature of 38.0 +/- 0.5, n = 10). The cerebrospinal fluid levels of neuron-specific enolase (NSE), S-100, brain-specific creatine kinase (CK-BB), and intracranial pressure (ICP) levels were used to assess the protective effects. The variations in pH and electrolyte balance were also examined. The results indicated that the peak ICP level in the normothermia group (26.30 +/- 1.08 mm Hg) was reached 48 h after TBI. The ICP level in the moderate hypothermia group was lower than in the control group at every time point examined (p < 0.01). Furthermore, at 24, 48, and 72 h, the NSE, S-100, and CK-BB levels in the moderate hypothermia group were also lower than that of the normothermia group (p < 0.01). In the moderate hypothermia group, the pH and electrolyte balance at the end of the monitoring period were normal, but the heart rates were lower (p < 0.05). There were a total of three deaths (13.6%) in this study: one in the moderate hypothermia group (8.3%) and two in the normothermia group (20%). In conclusion, moderate hypothermia provided neuronal protection for children with severe TBI, and maintaining the intracranial temperature at 34.5 degrees C for 72 h was safe in this clinical setting.
本研究探讨了亚低温对严重创伤性脑损伤（TBI）患儿的安全性和神经保护作用。22 名 TBI 患儿随机分为亚低温组（颅内温度 34.5±0.2°C，维持 72 小时，n=12）和常温组（颅内温度 38.0±0.5°C，n=10）。通过检测神经元特异性烯醇化酶（NSE）、S-100、脑特异性肌酸激酶同工酶（CK-BB）和颅内压（ICP）水平来评估保护作用。还检查了 pH 值和电解质平衡的变化。结果表明，常温组的 ICP 峰值（26.30±1.08mmHg）在 TBI 后 48 小时达到。亚低温组在每个检测时间点的 ICP 水平均低于对照组（p<0.01）。此外，在 24、48 和 72 小时时，亚低温组的 NSE、S-100 和 CK-BB 水平也低于常温组（p<0.01）。在亚低温组，监测期末的 pH 值和电解质平衡正常，但心率较低（p<0.05）。本研究共有 3 例死亡（13.6%）：亚低温组 1 例（8.3%），常温组 2 例（20%）。结论：亚低温对严重 TBI 患儿提供了神经元保护作用，在这种临床环境下将颅内温度维持在 34.5°C 72 小时是安全的。
