颅内压监测下亚低温治疗重型颅脑损伤的临床研究被引量：6

Clinical study on treatment of severe traumatic brain injury with mild hypothermia under intracranial pressure monitoring

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摘要目的研究颅内压监测下亚低温治疗重型颅脑损伤患者的临床效果。方法将100例重型颅脑损伤(sTBI)患者按随机数字表法分为对照组与亚低温组,每组各50例。两组患者入院后均予以常规对症治疗;亚低温组患者加用亚低温治疗,控制直肠温度(RT)为32℃~34℃;对照组患者控制RT在36℃~37℃;均监测患者的脑组织氧分压(PbtO_2)和颅内压(ICP)。比较两组患者入院时、入院24 h、48 h、72 h、96 h的ICP、脑组织PbtO_2及血乳酸、脑源性神经细胞营养因子(BDNF)水平的变化;治疗前、后给患者进行美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥预后量表(GOS)评分;统计两组并发症发生率。结果 (1)入院时,两组ICP、PbtO_2比较,差异无统计学意义(均P>0.05);入院24 h、48 h、72 h、96 h,两组ICP均降低、PbtO_2均升高,亚低温组入院不同时间点ICP均低于、PbtO_2均高于对照组(均P<0.05)。(2)入院时,两组血乳酸、BDNF水平比较,差异无统计学意义(均P>0.05);入院24 h、48 h、72 h、96 h,两组的血乳酸水平降低,BDNF水平上升;亚低温组入院后各时间点血乳酸水平低于、BDNF水平高于对照组(均P<0.05)。(3)治疗前,两组NIHSS、GOS评分的差异无统计学意义(均P>0.05);治疗后3个月时,两组的NIHSS评分均降低,GOS评分均上升,但亚低温组的NIHSS评分低于、GOS评分高于对照组,差异有统计学意义(均P<0.05)。(4)亚低温组的并发症发生率略低于对照组,但差异无统计学意义(P>0.05)。结论 ICP监测下亚低温治疗重型颅脑损伤可快速降低患者的ICP,改善其神经功能及预后。 Objective To study the clinical effect of mild hypothermia under intracranial pressure（ ICP）monitoring in the treatment of severe traumatic brain injury（ sTBI）. Methods A total of 100 patients with s TBI were enrolled in the study. They were randomly divided into the control group and the observation group by random number table method,50 cases in each group. All patients were given symptomatic treatment after admission. The observation group were additionally given mild hypothermia therapy and the rectal temperature（ RT） was controlled at 32 ℃ ~34 ℃,while RT of the control group was controlled at 36 ℃ ~ 37 ℃. The partial pressure of brain tissue oxygen（ PbtO_2） and ICP were monitored. Changes of ICP,PbtO_2,blood lactic acid and brain derived neurotrophic factor（ BDNF） in the two groups on admission,at 24 h,48 h,72 h and 96 h after admission were compared. Changes of scores of National Institutes of Health Stroke Scale（ NIHSS） and Glasgow Outcome Scale（ GCS） before and after treatment were recorded,and the incidence of complications in the two groups was statistically analyzed. Results（ 1）On admission,there was no statistically significant difference between the two groups in ICP and PbtO_2（ all P 0. 05）. 24 h,48 h,72 h and 96 h after admission. ICP was decreased while PbtO_2 was increased in two admission groups. ICP was lower in the observation group whlie PbtO_2 was higher than the control group at different time points after admission（ all P 0. 05）.（ 2） On admission,there was statistically significant differences between the two groups in levels of blood lactic acid and BDNF（ all P 0. 05）. 24 h,48 h,72 h and 96 h after admission,blood lactic acid levels were decreased and BDNF levels were increased in the two groups. Blood lactic acid levels were lower and BDNF levels were higher in the observation group than the control group at different time points after admission（ all P 0. 05）.（ 3） Before treatment,there was statistically significant differen