摘要
目的分析冰盐水联合冰帽与冰毯的亚低温疗法对重症脑卒中和颅脑外伤患者的临床疗效及神经功能的恢复作用，为亚低温治疗方案的临床应用提供可靠的临床资料。方法收集重症脑卒中和颅脑损伤（格拉斯哥昏迷评分GCS≤8分）患者84例，为脑出血、脑梗死、颅脑外伤三种常见并且脑损伤致脑功能异常（GCS≤8分）的疾病，发病均在12h以内。脑出血、脑梗死均为高血压性脑血管病变，排除合并心、肝、肾、血液及其他病变。颅脑外伤排除伴胸、腹、四肢等其他器官复合伤患者。按入院时间段分为对照组和观察组，每组42例。2组均给予保持呼吸道通畅、预防感染、脱水、降低颅内压以及胞二磷胆碱、脑复康、神经节苷脂钠等常规治疗，对照组采用联合冰帽和冰毯的亚低温疗法，观察组采用冰盐水联合冰帽和冰毯的亚低温疗法。对患者入院时进行GCS评分和6个月时分别进行神经系统GCS评分与格拉斯哥预后评分（GOS评分），并对治疗12个月后的生活质量采用KPS评分进行评估。结果发病至开始亚低温治疗的时间及开始实施亚低温至目标低温的时间，观察组为（8±4）h和（3±1）h，对照组为（16±5）h和（6±2）h，2组比较差异均有统计学意义（P〈0．05）。观察组和对照组患者6个月时的GCS评分分别是（7．01±1．12）和（4．02±1．11），观察组明显优于对照组（P〈0．05）；根据GOS评分将患者6个月时的神经系统评分分为良好、中残及不良，观察组GOS评分良好明显优于对照组（P〈0．05），中残组的差异无统计学意义（P〉0．05），不良观察组GOS评分明显次于对照组（P〈0．05）。治疗12个月后评估生活质量（KPS评分），观察组的远期生活质量明显优于对照组（P〈0．05）。结论对重症脑卒中和颅脑外伤患者采用冰盐水联合冰帽和冰毯的亚低温疗法，较采用单纯冰帽与冰毯的亚低温疗法，具有更好的脑保护作用。
Objective To study the moderate hypothermia with iced saline given intravenously with ice cap and ice sheet used in patients with severe stroke or craniocerebral trauma in order to clarify its clinical therapeutic effect and recovery of neurologic function for providing reliable clinical data. Methods A total of 84 patients suffered severe stroke （cerebral hemorrhage or cerebral infarction） or traumatic brain injury with GCS （ Glaseow Coma Scale） 〈 8 admitted within 24 hours after onset were enrolled for study. The exclusion criteria were functional deeompemsation of heart, liver, kidney and lung as cardiovascular complications of hypertension, hematological and other diseases, and craniocerebral trauma with multiple injuries of thorax, abdomen and extremities. Patients were divided into observation group and control group （n =42 in each group）. The patients of two groups were managed to maintain respiratory tract patent,prevention of infection, dehydration, reduction of intracranial pressure and treated with Cytidine Diphosphate Choline, piracetam, ganglioside sodium and other conventional therapy. In control group, patients treated with ice cap and ice sheet, whereas in observation group, patients were treated with iced saline injected intravenously in addition to ice cap and sheet. At admission, the GCS score of patients was assessed and 6 months later, GCS score and Glascow Outcome Scale, （GOS） score of patients were determined, and 12 months after the treatment, quality of life score were evaluated by KPS. Results The time from onset of stroke or from trauma accident occurred to initiation of hypothermia treatment and time from initiation of hypothermia therapy to the target temperature reached in observation group were （ 8 ± 4） hours and （ 3 ± 1 ） hours respectively, and in control group, they were （16 ±5） hours and （6 ±2） hours, and there were significant differences between two groups （ P 〈 0. 05 ）. The mean GCS score of patients at 6 months in the observation group and in the control group were （7.01 ± 1.12） and （4.02± 1.11） respectively （P 〈 0. 05 ） ; whereas the GOS score at 6 months of patients was categorized into good outcome, disabled outcome and poor outcome, and the good outcome in the observation group was significantly better than that in the control group （P 〈 0. 05 ）, and no statistically significant difference in disabled outcome was found between two groups （ P 〉 0. 05 ）, and the poor outcome of GOS score was significantly lower in observation group than that in control group （ P 〈 0. 05）. Twelve months after the treatment, the long-term quality of patients＇ life assessed by KPS score in observation group was significantly better than that in control group （ P 〈 0. 05 ）. Conclusions The moderate hypothermia therapy by using iced saline administered intravenously combined with ice cap and ice sheet for severe stroke and head trauma patients conferred better therapeutic effects than the treatment with ice cap and ice sheet.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第7期741-745,共5页
Chinese Journal of Emergency Medicine
关键词
重症
脑卒中
颅脑外伤
冰盐水
亚低温
预后
Severe
Stroke
Craniocerebral trauma
Ice brine
The low temperature
Prognosis
