体温控制对高血压脑出血术后预后的影响.doc

体温控制对高血压脑出血术后36.5～37.5℃）、亚低温组和常规降温组，各10例。监测患者的生命体征、颅内压、血气、血小板和凝血常规，复查术后第4日头颅CT观察颅内出血和梗塞，评价术后3个月患者神经功能（ADL分级标准）。结果：与常规降温组比较，研究组和亚低温组术后颅内再次出血和梗塞发生率更低，ADL良好率更高，死亡率降低，有显著性差异（P0.05）。与亚低温组比较，研究组对血小板和凝血常规无影响。结论：高血压脑出血患者术后将体温控制在36.5～37.5℃，可降低术后病死率，提高患者生存质量。 关键词：体温控制；高血压脑出血术Prognosis effect of controlling temperature on postoperation patients with hypertensive intracerebral hematoma HUANG De-jiu，YIN Zhi (The People’s Hospital of Zizhong County of Sichuan Province, Sichuan , Zizhong ,641200) Abstract：Objective To explore prognosis effect of controlling temperature on postoperation patients with hypertensive intracerebral hematoma. Methods 30 cases were randomly divided into the research group (the rectal temperature remained 36.5～37.5℃ ), the mild hypothermia group and the conventional hypothermia group, each group had 10 cases. The vital sign, intracranial pressur, blood gas values, platelet，PT and APTT were measured. According to ADL, the prognosis of the patients was evaluated. Results In comparision with the conventional hypothermia group, the mortality of the mild hypothermia group and research group decreased and good recovery casas increased, the prognosis of the patients improved. But it was not influence on the platelet，PT and APTT. Conclusion The rectal temperature remained 36.5～37.5℃ can reduce the mortality and improve the prognosis to the post-operation patients with hypertensive intracerebral hematoma. Key words: controlling temperature；hypertensive intracerebral hematoma；postoperation；prognosis 36.5～37.5℃，与亚低温治疗和常规降温进行比较，分析其对预后的影响。 1 临床资料 1.1 一般资料 研究对象为2005年1月至2008年12月本院高血压脑出血术后、无严重心血管疾患患者30例，GCS评分5-9分，其中男20例，女10例，年龄38～66岁。手术方式为去骨瓣减压开颅血肿清除术15例，侧闹室血肿穿刺引流9例，小骨窗开颅血肿清除术6例。随机分为研究组（体温维持在36.5～37.5℃）、亚低温治疗和常规降温3组，每组10例，3组患者临床特征无统计学差异。 1.2 方法 所有患者术后入ICU，备好降温毯。研究组始终将体温维持在36.5～37.5℃， 高于37℃即开始降温但不能低于36.5℃；亚低温治疗组采用呼吸机辅助呼吸，入室即开始应用降温毯降温，温度设置低线32℃，上限34℃，使体温维持在32～34℃，同时根据情况适当给予冬眠合剂和肌松剂；常规降温组高于38.5℃开始降温，低于38℃停止；3 组患者均持续72h并监测肛温，其余治疗相同。 1.3 观察项目 持续监护并记录患者生命体征和颅内压；每隔12h监测血气、血小