亚低温治疗（Mild hypothermia therapy）.docVIP

亚低温治疗（Mild hypothermia therapy） Indications, contraindications and procedures of brain protective treatment for severe traumatic brain injury [indications] 1. primary or secondary brain stem injury. 2., hypothalamus and other brain midline structural damage associated with central hyperthermia. 3. severe extensive contusion and laceration of brain, obvious brain edema and no indication of operation. 4. intracranial hematoma after surgical removal, there are still serious brain edema. [contraindication] 1. late brain hernia, brain stem function has been completely failure. 2., the observation period of intracranial hematoma can not exclude the need for surgical treatment. 3. severe combined injuries and shock have not been corrected. 4., the original serious cardiopulmonary dysfunction. [operation steps] 1. tracheotomy with an endotracheal tube inserted into the air sac. 2.ICU monitoring intracranial pressure, central venous pressure, cerebral blood flow velocity, Anal temperature, ECG, blood oxygen saturation and vital signs (including blood pressure, respiration, heart rate, pulse, etc.). 3. put the patient naked on the ice blanket and cool the ice in the bilateral neck, armpit and groin area. 4. intravenous muscle relaxant cockstailytic (400mg, 100mg, adding tracrium chlorpromazine and promethazine 100mg physiological saline 500ml), according to the patients body temperature, heart rate, blood pressure and muscle tension, adjust the dropping speed. The induction temperature is about 40ml/h, and the mild hypothermia is about 10ml/h. 5. after the patient has automatic breathing, use a respirator to keep breathing. 6. gradually reduce the patients body temperature to 32~34 degrees of treatment, maintain a smooth, low temperature limit of not less than 30 degrees centigrade. 7. improve respiratory tract management during the period of cooling and prevent complications such as lung infection. Daily blood glucose, blood electrolytes, blood coagulation function and blood