Tang Chunhai, Bao Yun, Qi Min, Zhou Lizhi, Liu Fan, Mao Jian, Lei Qingmei, Qi Songtao, Qiu Binghui
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China; Department of Neurosurgery, Tenth Affiliated Hospital, Guangxi Medical University, Guangdong Province, China.
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China.
J Crit Care. 2017 Jun;39:267-270. doi: 10.1016/j.jcrc.2016.12.012. Epub 2016 Dec 29.
To evaluate the efficacy and safety of mild induced hypothermia for intracranial hypertension in patients with traumatic brain injury after decompressive craniectomy.
A total of 60 adults with intracranial pressure (ICP) of more than 20 mm Hg after decompressive craniectomy were randomly assigned to standard care (control group) or hypothermia (32°C-35°C) plus standard care. Then, ICP, cerebral perfusion pressure, Glasgow Outcome Scale score, and complications were assessed.
There was a significant difference in ICP and cerebral perfusion pressure between the 2 groups. Favorable outcomes occurred in 12 (40.0%) and 7 (36.5%) patients in the hypothermia and control groups, respectively (P=.267). Kaplan-Meier curves revealed a marked difference in survival between the hypothermia and control groups (P=.032). There were significant differences in pulmonary infection and electrolyte disorders between the hypothermia and control groups (P=.038 and .033, respectively).
Mild induced hypothermia can reduce intracranial hypertension after decompressive craniectomy, decreasing patient mortality. Hypothermia should be considered one of the main treatments for intracranial hypertension after decompressive craniectomy in patients with traumatic brain injury.
评估亚低温疗法对减压性颅骨切除术后创伤性脑损伤患者颅内高压的疗效及安全性。
选取60例减压性颅骨切除术后颅内压（ICP）高于20 mmHg的成年患者，随机分为标准治疗组（对照组）和亚低温（32°C - 35°C）联合标准治疗组。随后，评估两组患者的ICP、脑灌注压、格拉斯哥预后评分及并发症情况。
两组患者的ICP和脑灌注压存在显著差异。亚低温组和对照组分别有12例（40.0%）和7例（36.5%）患者预后良好（P = 0.267）。Kaplan - Meier曲线显示亚低温组和对照组在生存率上存在显著差异（P = 0.032）。亚低温组和对照组在肺部感染和电解质紊乱方面存在显著差异（分别为P = 0.038和0.033）。
亚低温疗法可降低减压性颅骨切除术后的颅内高压，降低患者死亡率。对于创伤性脑损伤患者减压性颅骨切除术后的颅内高压，应将亚低温疗法视为主要治疗方法之一。
