摘要
背景:新近研究表明,急性期各种原因蛛网膜下腔出血所致脑血管痉挛的脑保护措施中,轻度低温的作用受到特别重视,并推荐临床应用。但多限于实验研究和动脉瘤出血,做临床研究亚低温可能对重型颅脑损伤的脑血管痉挛期有重要影响。目的:以脑循环动力学指标变化观察亚低温对重型颅脑损伤后脑血管痉挛期的脑保护作用。设计:随机对照实验。单位:解放军第十六医院神经外科和解放军第一军医大学珠江医院全军神经医学研究所。对象:选择1997-07／1999-08解放军第一军医大学珠江医院全军神经医学研究所收治36例重型颅脑损伤患者随机分为对照组和治疗组,每组18例。同期筛选出24例正常人检测其脑循环动力学指标,作为正常组,所有被试对象均自愿参加本实验。方法:对照组和治疗组均给予抗炎、止血、限液、脱水、支持、高压氧等治疗。对照组维持正常体温,治疗组4-8 h内将肛温降至33℃左右,维持 3-5 d。监测项目:①伤灶脑水肿体积:每例患者伤后当天(0),1,3,7, 14,21 d各行1次CT检查,计算伤灶脑水肿体积。②脑循环动力学指标:于伤后当天(0,未治疗前),1,3,7,10,14,21天每例患者各检测1 次,其中最低血流速度和最低血流量是反映检测点远端脑血管供血状态和血流量的指标,脑血管阻力反映脑微循环通畅程度的指标,动态阻力反映脑血管自动调节功能。评估标准:伤后1周按格拉斯哥昏迷评分判定意识恢复情况,3个月后按格拉斯哥预后评分评定预后良好和预后不良(5分良好,4分中残,3分重残,2分植物状态,1分死亡)。4分以上为预后良好。主要观察指标:①对照组和治疗组动态脑循环动力学指标和脑血管痉挛发生率。②对照组和治疗组动态伤灶脑水肿体积。③对照组和治疗组伤后1周意识恢复情况和预后情况。结果:36例重型颅脑损伤患者全部进入结果分析。①与正常�
BACKGROUND： It is indicated in latest research that in cerebral protective measures of cerebral vasospasm induced by subarachnoid hemorrhage due to various factors in acute stage, mild hypothermia has been drawn the attention specially and it has been recommended in clinical practice. But such therapy is generally limited in experimental research and aneurysm hemorrhage, the clinical research on subhypothermia probably provides important influence on cerebral vasospasm in severe craniocerebral injury. OBJECTIVE： Based on cerebral vascular hemodynamical indexes （CVDI）, the cerebral protection of subhypothermia was observed on cerebral va- sospasm in severe craniocerebral injury. DESIGN： Randomized controlled experiment. SETTING： Department of Neurological Surgery of No.16 Hospital of Chinese PLA and General Military Institute of Neurological Medical Science in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA. PARTICIPANTS： Totally 36 cases of severe craniocerebral injury were selected in General Military Institute of Neurological Medical Science in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA from July 1997 to August 1999, which were randomized into the control and treatment group, 18 cases in each one. At same period, 24 cases with normal CVDI were screened and taken as normal group. All of receptors participated in the experiment in volunteer. METHODS： In both the control and treatment group, the treatment was applied with anti-inflammation, stopping bleeding, fluid limitation, dehydration, supporting, hyperbaric oxygen, etc. In the control, the normal body temperature was maintained and in treatment group, anus temperature was dropped to about 33℃ in 4 hours to 8 hours, which was maintained for 3- 5 days. Items of supervision： ①Volume of cerebral edema in focus： CT test was given on the day of injury （0）, on the 1^st, 3^rd, 7^th, 14^th and 21^st days successively to calculate volume of cerebral edema in focus.② CVD
出处
《中国临床康复》
CSCD
北大核心
2005年第41期138-141,共4页
Chinese Journal of Clinical Rehabilitation
基金
全军医药卫生"九五"攻关课题(96Z008)获首届"涂通今奖学金""全军临床医学中青年人才培养基金"资助
