围术期亚低温治疗重型颅脑损伤的临床观察

临床医学论文-围术期亚低温治疗重型颅脑损伤的临床观察 【摘要】目的通过对重型颅脑损伤患者术中进行亚低温治疗后的疗效观察， 探讨围术期亚低温疗法对此类患者的脑保护作用及临床意义。方法56例重型颅脑 损伤患者GCS评分38分随机分为亚低温治疗组和对照组。亚低温组患者伤后 入手术室行亚低温治疗，脑温控制于32C35C 对照组行常温治疗。治疗过程 中观察两组患者的颈动脉和颈静脉血气、电解质变化、颅内压ICP和脑组织氧分 压PbtO2及血压、心率、呼吸等生命体征。对两组患者的预后情况进行GOS评分。 结果亚低温治疗组患者的脑氧摄取CE02和脑动静脉氧压差A-VD02均明显低 于对照组，差异均有统计学意义t分别14.89、10.19 ”均0.05；亚低温治 疗组患者的高ICP于术后3、7d明显低于对照组，差异均有统计学意义t分别 2.79，6.89，P均0.05；亚低温治疗组患者的PbtO2于术后3d起就明显高于 对照组患者，差异均有统计学意义t分别4.11、6.90 ”均0.05；经GOS预 后评分，亚低温治疗组患者中恢复良好67.86 19/28与对照组39.2811/28 比较，差异有统计学意义％23.42，P0.05；死亡率为14.29 4/28，与对 照组32.149/28比较，差异有统计学意义24.41 P0.05。结论 围术 期亚低温治疗能降低脑外伤后升高的ICP，提高PbtO2，具有明显的脑保护作用， 能有效改善重型颅脑损伤患者的预后，无严重并发症 【关键词】重型颅脑损伤亚低温治疗围术期 Abstract Obj ect ive To explore cerebral protective effect and clinical significance of perioperative mi Id hypothermia therapy in patients with severe brain injury. s Fifty six patients with severe craniocerebral injury were randomly divided into treatment groupn28 and control group n28 .After entered into operat ion room，mi Id hypothermia therapy group received cooling 32〜35C ， control group received room temperature. Carotid artery and vein blood gas , electrolyte, ICP, PbtO2, blood pressure,HR during the course of the treatment were observed. Prognosis of patients in two groups was uated by GCS. Results The results of the mi Id hypothermia therapy group were significantly lower than those of the controls t二14.89, 10.19，P0.05 in CE02 and A-VD02. The results of the mi Id hypothermia therapy group were significantly lower than those of the cont rols t2.79 ， 6.89, P0.05 in I CP at 3 〜7d after operat ion.The results of the treatment group were significantly lower than those of the controls t4.11 5 6.90 ， P0.05 in PbtO2 3 days postoperative. uated by GCS score 19 patients recovered well 67.86 ,4 patients died 14.29 in mi Id hypothermia therapy group,and 11 patients recovered well39.28 ,9 died32.14in control group. There were significantly differences between two groups x23.42,4.41,P0.05.Conclusions The treatment of perioperative mi Id hypothermia can decrease ICP , increase PbtO2 in brain injury and protect brain remarkably. Also it can effectively improve prognosis of severe brain injury without serious complications. Key words severe brain injury; mi Id hypothermia therapy; perioperative 重型颅脑损伤后由于脑组织缺血、缺氧，严重影响患者预后，且脑损伤致死 的总死亡率可以达到50［1］，死亡患者中脑缺血、缺氧的发生率高达80〜90 ［2］。亚低温治疗已被广泛应用于重型颅脑损伤。本次研究对56例重型颅脑损伤 患者的围术期亚低温治疗情况进行分析。现报道如下。 1资料与方法 1.1 一般资料 选择2006年10月至2007年12月武义县第一人民医院收治的56例重型颅脑 损伤患者［格拉斯哥昏迷量表（Glascow coma scale , GCS）评定GCS8分］ 其 中硬脑膜外血肿19例、硬脑膜下血肿17例、脑内血肿8例、混合性血肿12例， 且无其它重要脏器损伤。其中男性31例，女性25例，年龄34〜65岁。将其用抽 签法随机分为亚低温治疗组和对照组（见表1），两组在GCS评分、性别、年龄、 体重方面差别均无统计学意义（P均〉0.05）。 1.2方法 所有患者行开颅血肿清除术治疗。入室后开放静脉，采用芬太尼2〜3“g/kg、 维库漠 O.lmg/kg、异丙酚2mg/kg进行麻醉诱导；吸人1〜2异氟醍，微 量泵输入异丙酚34mg-kg-l-h-l进行麻醉维持；间断静注维库漠被维持肌肉 松弛，行气管插管并接呼吸机进行辅助呼吸。亚低温治疗组于诱导后使用半导体 降温毯YBT54-07A，由北京富业生物技术开发公司生产进行降温，术中将脑温探 头和颅内压探头置于硬脑膜下腔，将其脑温控制在32C