摘要
目的 研究亚低温对重型颅脑损伤 (SHI)后脑循环动力学的影响及其临床意义。 方法 36例SHI患者 ,随机分为常规治疗组和亚低温组 ,各 18例。用脑循环动力学检测仪检测伤后 0 ,1,3,7,10 ,14,2 1d的脑循环动力学指标 (CVDI) ,结合CT动态观察 ,分析两组CVDI变化规律、伤灶脑水肿大小和预后。 结果 与正常组比较 ,常规治疗组伤后CVDI可划分为四个期 ,即低灌注期 (0d)、高灌注期 (1～ 3d)、脑血管痉挛期 (4～ 14d)、好转期 (>15d) ;而亚低温组仅表现出三个期 ,即低灌注期 (0d)、好转期 (1～ 3d)、恢复期 (>4d)。常规组和亚低温组CVDI出现脑血管痉挛 (CVS)变化者分别是 8 18例和 2 18例 (P <0 .0 5 ) ,初步得出诊断外伤性CVS的CVDI参考值。伤灶脑水肿体积 :常规组在伤后第 14天最大 [(140 .9± 2 2 .95 )cm3],亚低温组在伤后第 3天最大[(95 .83± 14.97)cm3],亚低温组比常规组在伤后第 14天减少 42 % (P <0 .0 5 )。伤后 1周内转清醒率 :常规组为 2 2 .2 % (4 18例 ) ,亚低温组为 5 5 .6 % (10 18例 ) (P <0 .0 5 ) ;预后良好率 :常规组为38.9% (7 18例 ) ,亚低温组为 6 6 .7% (12 18例 )。 结论 亚低温通过稳定SHI后脑循环功能 ,减轻脑水肿 ,改善预后。CVDI动态变化可做为SHI后亚低温治疗时程。
Objective To investigate the effect of mild hypothermia on cerebral hemodynamics after severe head injury (SHI) and its clinical significance. Methods Thirty-six patients with SHI were randomly divided into the conventional therapy group(n = 18) and the mild hypothermic therapy group(n = 18). Cerebrovascular hemodynamic indices (CVDI) were measured with a cerebrovascular hemodynamics analyzer before SHI, and at 1, 3, 7, 10, 14 and 21 d after SHI, respectively. The changing phase of CVDI, the size of brain edema in the traumatic focus and the prognosis were compared and analyzed through the combination of CT dynamic observation. And 24 normal persons were selected to measure the normal value of CVDI. Results Compared with the normal group, the posttraumatic CVDI in the conventional group could be divided into 4 phases: hypoperfusion(0 d),high-perfusion (1 to 3 d),cerebral vasospasm (4 to 14 d)and intermediary ( more than 15 d ). And there were 3 phases in the mild hypothermic group: hypoperfusion (0 d), intermediary (1 to 3 d), and recovery (more than 4 d). There were 8 cases and 2 cases of cerebral vasospasm (CVS) in the CVDI of the conventional group and the mild hypothermic group, respectively ( P < 0.05). According to clinic trials, we obtained the elementary reference value of CVDI for diagnosing the traumatic CVS. The volume of brain edema was the largest on the 14th day after injury for the conventional group [(140.9±22.95)cm 3] and on the 3rd day after injury for the mild hypothermia group [(95.83±14.97)cm 3], which decreased by 42% on 14th day after injury in the mild hypothermic group than that in the conventional group ( P <0.05). The consciousness rates in a week were 22.2%(4/18) in the conventional group and 55.6% (10/18) in the mild hypothermia group ( P <0.05). The rates of good prognosis were 38.9% (7/18) in the conventional group and 66.7% (12/18) in the mild hypothermic group. Conclusions Mild hypothermia can improve the prognosis through stabilizing the cerebral circulation and alleviating brain edema after SHI. The dynamic changes of CVDI may be employed as an objective reference index for determining the time of mild hypothermia treatment, the prevention of cerebral vasospasm and the assessment of prognosis after SHI.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2000年第10期603-606,共4页
Chinese Journal of Trauma
基金
全军医药卫生"九五"攻关课题!(NO .96Z0 0 8)
首届"涂通今奖学金"资助
"全军临床医学中青年人材培养基金"资助
关键词
重型颅脑损伤
亚低温治疗
脑循环动力学
Brain injury, severe
Cerebrovascular circulation
Prognosis
Mild hypothermia
