Idris Zamzuri, Zenian Mohd Sofan, Muzaimi Mustapha, Hamid Wan Zuraida Wan Abdul
Center for Neuroscience Service and Research, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia ; Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Asian J Neurosurg. 2014 Jul-Sep;9(3):115-23. doi: 10.4103/1793-5482.142690.
Induced hypothermia for treatment of traumatic brain injury is controversial. Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent, regional brain hypothermia is thought capable to mitigate those processes. The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale (GCS) 6-7.
A prospective randomized controlled pilot study involving patients with severe traumatic brain injury with GCS 6 and 7 who required decompressive craniectomy. Patients were randomized into two groups: Cooling and no cooling. For the cooling group, analysis was made by dividing the group into mild and deep cooling. Brain was cooled by irrigating the brain continuously with cold Hartmann solution for 24-48 h. Main outcome assessments were a dichotomized Glasgow outcome score (GOS) at 6 months posttrauma.
A total of 32 patients were recruited. The cooling-treated patients did better than no cooling. There were 63.2% of patients in cooling group attained good GOS at 6 months compared to only 15.4% in noncooling group (P = 0.007). Interestingly, the analysis at 6 months post-trauma disclosed mild-cooling-treated patients did better than no cooling (70% vs. 15.4% attained good GOS, P = 0.013) and apparently, the deep-cooling-treated patients failed to be better than either no cooling (P = 0.074) or mild cooling group (P = 0.650).
Data from this pilot study imply direct regional brain hypothermia appears safe, feasible and maybe beneficial in treating severely head-injured patients.
诱导低温治疗创伤性脑损伤存在争议。由于继发性脑损伤病理生理学中涉及的许多途径都与温度有关，因此认为局部脑低温能够减轻这些过程。本研究的目的是评估局部脑降温对格拉斯哥昏迷量表（GCS）评分为6 - 7分的重度颅脑损伤患者的治疗效果及并发症。
一项前瞻性随机对照试验研究，纳入需要进行减压颅骨切除术、GCS评分为6分和7分的重度创伤性脑损伤患者。患者被随机分为两组：降温组和非降温组。对于降温组，又分为轻度降温和深度降温两组进行分析。通过用冷的哈特曼溶液持续冲洗大脑24 - 48小时来进行脑部降温。主要结局评估指标是伤后6个月时二分法的格拉斯哥预后评分（GOS）。
共招募了32名患者。接受降温治疗的患者比未接受降温治疗的患者预后更好。降温组63.2%的患者在6个月时获得了良好的GOS，而非降温组仅为15.4%（P = 0.007）。有趣的是，伤后6个月的分析显示，轻度降温治疗的患者比未降温的患者预后更好（70% vs. 15.4%获得良好GOS，P = 0.013），显然，深度降温治疗的患者并未比未降温组（P = 0.074）或轻度降温组（P = 0.650）表现更好。
这项初步研究的数据表明，直接局部脑低温治疗重度颅脑损伤患者似乎是安全、可行的，且可能有益。
