Masaoka Hiroyuki
Department of Neurosurgery, School of Medicine, Tokyo Medical and Dental University.
J Med Dent Sci. 2010 Jun;57(2):133-8.
Cerebral blood flow (CBF) measurements during mild hypothermia therapy were made in 30 adult patients with severe head injuries (Glasgow Coma Scale score < or =18), by xenon enhanced computed tomography (Xe-CT). All patients but one underwent removal of hematomas and decompressive craniectomy. Immediately after surgery, hypothermia was induced by surface cooling, and a brain temperature of 32-35 degrees C was maintained for 3 days. During hypothermia therapy, CBF measurements by Xe-CT were made for all patients on post-injury days 1 to 4. From the arteriovenous-oxygen content difference and CBF values, the cerebral metabolic rate of oxygen (CMRO2) values were obtained. Outcome was assessed at discharge according to the patients' Glasgow Outcome Scale (GOS) scores. Patients were divided into two groups based on their outcomes. Nineteen patients (63%) showed good outcomes (GOS score of 4 or 5) and 11 (37%) showed poor outcomes (GOS score of 1, 2, or 3). Statistically significant differences were obtained for the mean global CBF and CMRO2 values between the good and poor outcome groups. In this study, we demonstrated that CBF measurement may be useful to predict neurological outcomes following severe traumatic brain injury in patients undergoing hypothermia as well as to identify those who might not likely benefit from hypothermia therapy.
采用氙增强计算机断层扫描（Xe - CT）对30例重度颅脑损伤成年患者（格拉斯哥昏迷量表评分≤18分）进行亚低温治疗期间的脑血流量（CBF）测量。除1例患者外，所有患者均接受了血肿清除术和去骨瓣减压术。术后立即通过体表降温诱导低温，并将脑温维持在32 - 35摄氏度3天。在亚低温治疗期间，于伤后第1至4天对所有患者进行Xe - CT脑血流量测量。根据动静脉血氧含量差和脑血流量值，得出脑氧代谢率（CMRO2）值。出院时根据患者的格拉斯哥预后量表（GOS）评分评估预后。根据预后将患者分为两组。19例患者（63%）预后良好（GOS评分为4或5），11例（37%）预后不良（GOS评分为1、2或3）。良好和不良预后组之间的平均全脑脑血流量和脑氧代谢率值存在统计学显著差异。在本研究中，我们证明脑血流量测量可能有助于预测接受亚低温治疗的重度创伤性脑损伤患者的神经学预后，并识别那些可能无法从亚低温治疗中获益的患者。
