Shui T, Guo Z Y, Zhang G Z, Chen Q, Li B
Department of Neurosurgery, Tianjin TEDA Hospital, Tianjin 300457, China.
Zhonghua Yi Xue Za Zhi. 2018 May 22;98(19):1489-1492. doi: 10.3760/cma.j.issn.0376-2491.2018.19.007.
Through studying the variations of cerebral blood flow velocity and cerebral extraction rate of oxygen to investigate the effect and mechanism of mild hypothermia therapy on early brain injury (EBI) and cerebral vasospasm (CVS) induced by sever subarachnoid hemorrhage (SAH). A total of 62 adult patients admitted in the Department of Neurosurgery of Tianjin TEDA Hospital from January 2014 to December 2016 with severe SAH without contraindications of hypothermia therapy were randomly divided into mild hypothermia (MH) group of 30 cases and routine treatment (RT) group of 32 cases.The general data were no significant difference.The routine treatment group got bloody cerebrospinal fluid drainage, spasmolysis, 3H treatment, etc.Besides conventional treatment, MH group got mild hypothermia therapy started on the day of admission within 2-8 hours, lower rectal temperature and maintained at (35±1) ℃, maintain 5-7 d. The mean velocity of middle cerebral artery blood flow (VmMCA) and Lindergaard index of two groups were detected by transcranial Doppler to indirectly evaluate the degree and evolution of CVS.Blood gas analysis was performed to obtain the blood oxygen content of the artery and jugular vein (CaO(2)/CjvO(2)) in the two groups at the same time, and the cerebral extraction rate of oxygen (CERO(2)) = (CaO(2)-CjvO(2))/CaO(2) was calculated. Within 5 times of admission d1, d2, d3, d7 and d14, mean results of VmMCA of RT group were significantly higher than those of the MH group at d2, d3, d7 and d14 on statistics.The changes of CERO(2) between MH group and RT group during the observation period were compared at the same time: there was no significant difference between d1 and d14 (>0.05); at d2, d3 and d7 showed marked differences, and that of the MH group was significantly lower than that of the RT group' (<0.01). The correlation analysis showed that it had a weak correlation between CERO(2) and VmMCA (>0.05) in the MH group, and CERO(2) was significantly positively correlated with VmMCA in the RT group (<0.01). MH therapy has a positive significance to reduce the incidence, degree and the duration of CVS.The relationship between CVS and the degree of hypoxia in brain was broken by the MH therapy to reduce the adverse effects of EBI through reducing metabolism, thereby alleviating hypoxia damage in brain tissue.Setting the appropriate target temperature and the course of treatment and then the gentle rewarming process can reduce the incidence of complications of hypothermia therapy.
通过研究脑血流速度和脑氧摄取率的变化，探讨亚低温治疗对重度蛛网膜下腔出血（SAH）所致早期脑损伤（EBI）和脑血管痉挛（CVS）的影响及机制。选取2014年1月至2016年12月在天津泰达医院神经外科住院的62例无亚低温治疗禁忌证的重度SAH成年患者，随机分为亚低温（MH）组30例和常规治疗（RT）组32例。两组一般资料差异无统计学意义。常规治疗组给予血性脑脊液引流、解痉、3H治疗等。MH组在常规治疗基础上，于入院当日2 - 8小时内开始亚低温治疗，降低直肠温度并维持在（35±1）℃，维持5 - 7天。采用经颅多普勒检测两组大脑中动脉血流平均速度（VmMCA）和Lindergaard指数，间接评估CVS的程度及演变。同时进行血气分析，获取两组动脉和颈静脉血氧含量（CaO₂/CjvO₂），计算脑氧摄取率（CERO₂）=（CaO₂ - CjvO₂）/CaO₂。入院后d1、d2、d3、d7和d14 5个时间点，统计学显示RT组在d2、d3、d7和d14时VmMCA均值显著高于MH组。同时比较MH组和RT组观察期内CERO₂的变化：d1和d14时差异无统计学意义（>0.05）；d2、d3和d7时差异有统计学意义，且MH组显著低于RT组（<0.01）。相关性分析显示，MH组CERO₂与VmMCA呈弱相关（>0.05），RT组CERO₂与VmMCA呈显著正相关（<0.01）。亚低温治疗对降低CVS的发生率、程度及持续时间具有积极意义。亚低温治疗打破了CVS与脑缺氧程度之间的关系，通过降低代谢减轻EBI的不良影响，从而减轻脑组织缺氧损伤。设定合适的目标温度、治疗疗程及缓慢复温过程可降低亚低温治疗并发症的发生率。
