临床神经外科杂志2017，Vol.14Issue(6)：453-456,4.DOI:10.3969/j.issn.1672-7770.2017.06.011
颅内压监测下亚低温治疗重型颅脑损伤的临床研究
Clinical study on treatment of severe traumatic brain injury with mild hypothermia under intracranial pressure monitoring
张学磊 1田达 1李湖广 1杜庆华 1朱缙伟 1孙顺进1
作者信息
- 1. 323000 浙江省丽水市人民医院神经外科
- 折叠
摘要
Abstract
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 sTBI 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 (PbtO2) and ICP were monitored.Changes of ICP,PbtO2,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 PbtO2 was increased in two admission groups.ICP was lower in the observation group while 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 differences between the two groups in NIHSS score and GOS score (all P>0.05).After 3 months of treatment,NIHSS scores of the two groups were decreased,and GOS scores were increased.After 3 months of treatment,NIHSS score of the observation group was lower than that of the control group,while GOS score was higher than that of the control group (all P <0.05).(4) The incidence of complications in the observation group was slightly lower than that in the control group (P>0.05).Conclusion Mild hypothermia under ICP monitoring can quickly reduce the ICP and improve the neurological function and prognosis of patients with sTBI.关键词
重型颅脑损伤/颅内压/亚低温Key words
severe craniocerebral injury/intracranial pressure/mild hypothermia分类
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张学磊,田达,李湖广,杜庆华,朱缙伟,孙顺进..颅内压监测下亚低温治疗重型颅脑损伤的临床研究[J].临床神经外科杂志,2017,14(6):453-456,4.
