文章摘要

不同时程亚低温治疗在重型颅脑损伤患者中的疗效比较

作者: 1余 菲, 1张 琳
1 安徽医科大学第三附属医院重症医学科,合肥 230001
通讯: 张 琳 Email: 2005202zhl@sina.com
DOI: 10.3978/j.issn.2095-6959.2019.02.017

摘要

目的:探讨不同时程亚低温治疗在重型颅脑损伤(severe traumatic brain injur y,sTBI)患者中的临床疗效差异。方法:采用前瞻性研究方法选取安徽医科大学第三附属医院本部及滨湖院区ICU在2016年8月至2017年12月收治的90例sTBI患者为研究对象,按照患者入院顺序随机分为常规组(A组,n=30)、长时间亚低温组(B组,n=30)、短时间亚低温组(简称C组,n=30)。A组仅给予基础治疗;B组在A组基础上入院后立即行亚低温治疗,体温控制在33~35 ℃,持续5 d;C组在A组基础上入院后立即行亚低温治疗,体温控制在33~35 ℃,持续2 d,比较3组患者治疗6 d后的临床疗效差异。结果:3组患者治疗前的颅内压(intracranial pressure,ICP)差异无统计学意义(P>0.05);治疗第6天,差异有统计学意义(P<0.05),且C组高于B组(P<0.05)。3组患者第6天的APACHE II评分差异有统计学意义(P<0.05),且C组高于B组(P<0.05)。在并发症发生率方面,A组高于其他2组(P<0.05),C组高于B组(P>0.05)。在28 d病死率方面,A组高于其他2组(P<0.05),C组高于B组(P>0.05)。结论:亚低温治疗在sTBI患者治疗中的效果显著,与短时间亚低温治疗相比,长时间亚低温治疗虽不能显著降低患者短时间内病死率,但能显著降低ICP、远期死亡风险,对并发症发生率增加没有显著影响。
关键词: 亚低温脑保护;重型颅脑损伤;疗效比较

Efficacy comparison of application of mild hypothermia therapy with different durations in patients with severe traumatic brain injury

Authors: 1YU Fei, 1ZHANG Lin
1 Department of Intensive Medicine, The Third Affiliated Hospital of Anhui Medical University, Hefei 230001, China

CorrespondingAuthor:ZHANG Lin Email: 2005202zhl@sina.com

Abstract

Objective: To study the clinical effect of mild hypothermia therapy with different durations in patients with severe traumatic brain injury (sTBI). Methods: A total of 90 patients with sTBI admitted to ICU of The First People’s Hospital of Hefei and Binhu Hospital from August 2016 to December 2017 were selected prospectively as the subjects, and all patients were randomly divided into a long-term mild hypothermia group (group A, n=30), a short-term mild hypothermia group (group B, n=30), and a conventional group (group C, n=30). Group A was given only basic treatment. Group B was treated with mild hypothermia after admission and the body temperature was controlled at 33–35 ℃, lasting 5 days. The group C was treated with mild hypothermia after admission and the temperature was controlled at 33–35 ℃ for 2 days. The clinical effects of the 3 groups were compared in the 6th day. Results: There was no significant difference in intracranial pressure (ICP) between the three groups before treatment (P>0.05), and the ICP was statistically significant on the 6th day after injury (P<0.05). The APACHE II scores of the 3 groups on the 6th day after injury were statistically significant (P<0.05), and the group C on the 6th day after injury was higher than that of the group B (P<0.05). The incidence of complications in the group A was higher than that in the group B and the group C (P<0.05). The incidence of complications in the group C was higher than that in group B (P>0.05), but the mortality in the group A was higher than that in the group B (P<0.05). The mortality rate in the group C was higher than that in the group B (P>0.05). Conclusion: The effect of mild hypothermia therapy on patients with sTBI is significant. Although long-term mild hypothermia therapy could not reduce the mortality rate significantly in a short period of time, it could reduce ICP and the risk of long-term death significantly. The incidence of patient complications is no significant increase.
Keywords: mild hypothermia brain protection; severe traumatic brain injury; comparison of efficacy