摘要
背景:动物实验和临床实践证实亚低温能有效减少继发性脑损伤,但其对内环境稳定有无影响尚不清楚。目的:检测亚低温物理技术并冬眠疗法对重度颅脑损伤患者血生化学及血气变化的影响,并与常温治疗患者进行比较。设计:完全随机对照实验。单位:山西博爱医院神经外科;北京市神经外科研究所;哈尔滨医科大学第一临床医学院神经外科。对象:选择2002-06/12在哈尔滨医科大学第一临床医学院神经外科住院治疗的脑出血或脑创伤患者24例。格拉斯哥昏迷指数为3～8分,年龄限制在35～60岁。患者均知情同意。随机分为亚低温/冬眠联合治疗组12例和常温治疗组12例。方法:在患者受伤10h之内,亚低温/冬眠联合治疗组患者给予1号冬眠合剂半量(氯丙嗪25mg,哌替啶50mg,异丙嗪25mg),并使用冰毯将其体温降至32～34℃(直肠温度)。维持该组患者体温在这一范围内5d,随后上升至35℃维持24h,然后撤去冰毯,让体温自然上升至正常水平。常温治疗组的体温始终维持在37～38℃。对全部患者的平均动脉压和心率进行连续监测,在入院后的第3天和第7天,检查颅内压、肌酸磷酸激酶、动脉血氧分压、动脉血二氧化碳分压、血小板计数和血K+、Na+离子的浓度。在第7天计算格拉斯哥昏迷量表评分和死亡率。主要观察指标:①两组患者颅内压、肌酸磷酸激酶活性、血小板计数、血K+浓度和血Na+浓度的下降值。②在入院后的第3天和第7天亚低温/冬眠联合治疗组的动脉血氧分压和二氧化碳分压。结果:24例患者均进入结果分析。①颅内压、肌酸磷酸激酶和血小板计数下降值:亚低温/冬眠联合治疗组显著高于常温治疗组[(104.09±54.90),(58.75±25.33)mmH2O;(26.95±19.22),(10.17±7.18)μkat/L;(89.82±46.36)×109/L,(48.83±44.59)×109/L,(t=1.92～3.56,P<0.05)]。②两组在平均动脉压、血K+、Na+离子下降值、动脉血氧分压和二�
BACKGROUND： Both animal experiments and clinical practice have confirmed that mild or moderate hypothermia is effective in reducing secondary brain injury, but its effect on homeostasis is not very clear. OBJECTIVE： To investigate the effect of a combined therapy of mild hypothermia and hibernation on the homeostasis of patients with severe brain injury. DESIGN： A randomized controlled study. SETTING： Neurosurgical Institute of Beijing; Neurosurgieal Department of the First Clinical Medical College Affiliated to Harbin Medical University; and Neurological Department of the Second Clinical Medical College Affiliated to Harbin Medical University. PARTICIPANTS： The study was conducted at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, from June to December 2002. Totally 24 patients （aged 35-60 years） with severe cerebral hemorrhage or brain injury were randomly divided into combined therapy group and normothermia group. Their Glasgow Coma Scale scores ranged from 3 to 8. The subjects signed the informed consent. METHODS： Within 10 hours of their injury, patients in hypothermia and hibernation combination group were given half dosage of No. 1 hibernation cocktail （chlorprnmazine 25 rag, pethidine hydrochloride 50 rag, and pmmethazine 25 rag）, and were cooled by cooling blankets to make their body temperature dropped to 32-34℃ （rectal temperature）. Their temperature was kept within this range for 5 days, at 35 ℃ for 24 hours, and then was slowly increased to their normal level. The body temperature of patients in normothermia group was maintained at 37-38 ℃. The mean arterial pressure anti heart rate of all patients were measured continuously by HP monitor. On the 3^nd and 7^th days of hospitalization, intracranial pressure and creatine phosphate kinase were measured via lumbar puncture. Femoral artery puncture was performed to check the partial pressure of arterial O2 and CO2. Platelets count and blood electrolytes K^± and Na^± concentration
出处
《中国临床康复》
CSCD
北大核心
2005年第33期175-177,共3页
Chinese Journal of Clinical Rehabilitation
基金
黑龙江省"九五"攻关基金(G98L19-13)
黑龙江省青年科研基金(Q99-19)资助项目~~
