Young-Su P, Ishikawa J
Department of Neurosurgery, Maizuru Municipal Hospital.
No Shinkei Geka. 1997 Jun;25(6):529-35.
Mild barbiturate-moderate hypothermia therapy was established for severe head injury and cerebrovascular disease. This study was conducted on 152 patients from April 1984 through July 1995. In this study were included patients with Glagow Coma Scale score of less than 8 points but those with serious systemic complications and elderly and infantile patients were excluded. Our protocol consisted of administration of thiamylal Na 1.25-2.5 mg/kg/h and droperidol 20-40 micrograms/kg/h (mild barbiturate) while maintaining a core temperature of 32-34 degrees C (moderate hypothermia). The clinical outcome was good (GR, MD) in 58 cases, poor (SD) in 24 cases and bad (PVS, D) in 70 cases. This therapy was found to be particularly effective for preventing ischemic neurological damage in the vasospasm stage following SAH and severe head injury in young patients. However, this therapy did not prevent pneumonia, cardiac failure, arrhythmia and hypopotassemia from occurring frequently. We conclude that this therapy is contraindicated in the elderly, i.e., those older than 65 years.
轻度巴比妥酸盐-中度低温疗法被用于治疗重度颅脑损伤和脑血管疾病。本研究于1984年4月至1995年7月对152例患者进行。本研究纳入格拉斯哥昏迷量表评分低于8分的患者,但排除有严重全身并发症的患者以及老年和婴幼儿患者。我们的方案包括静脉滴注硫喷妥钠1.25 - 2.5毫克/千克/小时和氟哌利多20 - 40微克/千克/小时(轻度巴比妥酸盐),同时将核心体温维持在32 - 34摄氏度(中度低温)。临床结果为良好(GR,MD)58例,不佳(SD)24例,差(PVS,D)70例。发现该疗法对预防蛛网膜下腔出血后血管痉挛期的缺血性神经损伤以及年轻患者的重度颅脑损伤特别有效。然而,该疗法不能预防肺炎、心力衰竭、心律失常和低钾血症的频繁发生。我们得出结论,该疗法对老年人(即年龄大于65岁者)为禁忌。