Nakamura T, Nagao S, Kawai N, Honma Y, Kuyama H
Department of Neurological Surgery, Kagawa Medical University, Japan.
Acta Neurochir Suppl. 1998;71:85-7. doi: 10.1007/978-3-7091-6475-4_26.
The therapeutic significance of moderate hypothermia and cerebral monitorings was assessed in the 10 patients with severe head injury. Cooling was begun as soon as possible after admission, using water blankets under general anesthesia. Jugular venous or tympanic temperature of patients was maintained at 32 degrees C for 3 to 5 days, then rewarming at the rate of 1 degree C a day was started. The intracranial pressure was controllable less than 20 mmHg under hypothermia. Moderate hypothermia reduced the jugular venous lactate (33.5%) as well as the cerebral blood flow velocity at M1 portion of middle cerebral artery (CBFV-M1) measured by transcranial Doppler (7.2%), while increase of the jugular venous oxygen saturation (SjO2) (17.9%) was observed in a majority of the patients. Our results demonstrated that moderate therapeutic hypothermia significantly reduced cerebral circulation and metabolism. Measurement of SjO2 and CBFV-M1 seems to be useful for estimation of cerebral circulation and metabolism in therapeutic hypothermia.
对10例重型颅脑损伤患者评估了亚低温及脑监测的治疗意义。入院后尽快开始降温，在全身麻醉下使用水毯。患者的颈静脉或鼓膜温度维持在32℃ 3至5天，然后开始以每天1℃的速度复温。低温状态下颅内压可控制在20 mmHg以下。亚低温降低了颈静脉乳酸含量（33.5%）以及经颅多普勒测量的大脑中动脉M1段的脑血流速度（CBFV-M1）（7.2%），而大多数患者的颈静脉血氧饱和度（SjO2）升高（17.9%）。我们的结果表明，亚低温治疗显著降低了脑循环和代谢。测量SjO2和CBFV-M1似乎有助于评估亚低温治疗中的脑循环和代谢。
