无创性头颈部降温法治疗重型颅脑损伤患者的神经保护作用

Abstract

研究无创性头颈部降温法作为无创性选择性脑亚低温方法在治疗重型颅脑损伤的临床效果。将90例重型颅脑损伤患者分成选择性脑亚低温组和常温组。利用亚低温治疗仪，对重型颅脑损伤患者采取头颈部密切敷贴方法取得无创性选择性脑亚低温(33˚C~35˚C)维持3天后自然复温。密切监测两组患者的颅内压等指标。结果显示，脑亚低温组、常温组在24、48、72 h的平均颅内压分别为19.14 ± 2.33 mmHg，19.72 ± 1.73 mmHg，17.29 ± 2.07 mmHg和23.41 ± 2.51 mmHg，20.97 ± 1.86 mmHg，20.13 ± 1.87 mmHg，前者较后者降低(P < 0.01)；6个月后2组恢复良好率(GOS评分4~5)分别为68.9%和46.7% (P < 0.05)，未见严重的并发症。本研究选用的头颈部降温法可取得选择性脑亚低温目标。该方法在治疗重型颅脑损伤患者中有降低颅内压，改善预后，而未见严重的并发症，是一种安全有效的治疗方法。 Therapeutic hypothermia is a promising treatment for patients with severe traumatic brain injury (TBI). We present here the results of a study in which noninvasive selective brain cooling (SBC) was achieved using a head cap and neckband. Ninety patients with severe TBI were divided into a normothermia control group (n = 45) and a SBC group (n = 45), whose brain temperature was maintained at 33 - 35 degrees Celsius for 3 days using a combination of head and neck cooling. At 24, 48 and 72 h after injury, the mean intracranial pressure (ICP) values of the patients who underwent SBC were lower than those of the normothermia controls (19.14 ± 2.33, 19.72 ± 1.73 and 17.29 ± 2.07 mmHg, versus 23.41 ± 2.51, 20.97 ± 1.86, and 20.13 ± 1.87 mmHg, respectively, P < 0.01). There was a significant difference in the neurological recovery of the two groups at the 6-month follow-up after TBI. Good neurological outcome (Glasgow Outcome Scale score of 4 to 5) rates 6 months after injury were 68.9% for the SBC group, and 46.7% for the control group (P < 0.05). There were no complications resulting in severe sequelae. In conclusion, the noninvasive SBC described here is a safe method of administering therapeutic hypothermia, which can reduce ICP and improve prognosis without severe complications in patients with severe TBI.