亚低温冬眠在重度脑挫裂伤治疗中应用研究.docVIP

亚低温冬眠在重度脑挫裂伤治疗中应用研究 　　[摘要] 目的:探讨亚低温冬眠疗法对重度脑挫裂伤患者的脑保护机制及临床疗效。方法:53例重度脑挫裂伤患者(格拉斯哥昏迷评分≤8分)随机分为亚低温组和常温组。其中亚低温组28例,入院后1～5 h内行亚低温冬眠治疗,输液泵持续静脉点滴冬眠合剂,肛温控制在32～35℃,亚低温冬眠治疗3～7 d,同时检测颈动脉和颈静脉血气、电解质、血糖及生命体征等指标。常温组25例除未行亚低温冬眠治疗外,其余综合治疗及监测方法同亚低温组。两组患者均于伤后3个月根据格拉斯哥预后评分(GOS)判定疗效。结果:与常温组比较,亚低温组脑氧耗明显降低,高血糖情况显著下降,生命体征及电解质等无明显差异,无严重并发症,死残率明显降低,预后显著改善。结论:亚低温冬眠疗法具有显著的脑保护作用,临床应用于重度脑挫裂伤救治安全有效,无严重并发症。 　　[关键词] 重度脑挫裂伤;亚低温冬眠疗法;预后 　　[中图分类号] R742.8+9 [文献标识码]A [文章编号]1674-4721(2010)05(b)-026-02 　　 　　Application of mild hypothermia hibernation in the therapy of severe brain trauma 　　HUANG Yangxiao 　　(Department of Neurosurgery, Dongkeng Hospital, Dongguan City, Guangdong province, Dongguan523451, China) 　　[Abstract] Objective: To investigate the protection and effect of mild hypothermia hibernation on severe brain trauma in clinic. Methods: 53 patients with severe brain trauma(GCS≤8) were randomly divided into two groups. 28 patients were treated with mild hypothermia within 1-5 hours for 3-7 days after injury, and at the same time sugar, gas and electrolyte in the blood were monitored. In control group 25 cases were treated consisted with the mild hypothermia group except mild hypothermia. Two groups were judged according to the GOS prognosis score at three months after brain trauma. Results: The mild hypothermia group showed low oxygen consumption, reduction of blood glucose and constant vital signs compared with control. Mild hypothermia therapy decreased mortality rate and improved prognosis without serious complication. Conclusion: Mild hypothermia therepy has an obvious protection in brain and can be applied to curing severe brain trauma in clinic. 　　[Key words] Sevre brain trauma; Mild hypothermia hibernation; Prognosis 　　 　　重度脑挫裂伤患者死亡率高,虽经积???治疗,仍有很多患者遗留各种并发症,如瘫痪、痴呆等。有关重度脑挫裂伤患者的治疗一直是神经外科领域研究的重要课题。本文以亚低温冬眠治疗本院53 例重度脑挫裂伤患者的结果为依据,探讨其脑保护的作用机制。为临床重度脑挫裂伤患者的治疗提供参考。 　　1 资料与方法 　　1.1 一般资料 　　本院2006年3月~2009年8月收治53 例重度脑挫裂伤患者。其中,男31例,女22例;年龄15～58岁,平均43岁;伤后6～24 h内收住院。所有患者均有头部外伤史,其中,交通事故伤37例,高