摘要
目的 探讨亚低温治疗重度弥漫性轴索损伤 (DAI)的疗效与机制。 方法 98例重度DAI患者分为亚低温组 65例 ,常温组 33例 ,观察亚低温治疗前后颅内压 (ICP)、脑灌注压 (CPP)、脑电地形图 (BEAM)、血内皮素 (ET)、经颅多普勒超声 (TCD)的变化及预后。 结果 亚低温治疗组ICP、CPP、BEAM及预后与常温组比较 ,差异有显著性意义 ,亚低温组血ET由治疗前的 (92 .31±1 1 .58)ng L降至伤后 7d的 (55 .83± 3 .83)ng L (P <0 .0 1 ) ,TCD示大脑中动脉平均血流速度 (Vm)由治疗前的 (65 .1± 4 .9)cm s降至伤后 7d的 (52 .7± 4 .3)cm s(P <0 .0 1 ) ,同时大脑中动脉收缩期血流速度 (Vs)、搏动指数 (PI)明显下降 ,其差异有非常显著性意义 (P <0 .0 1 )。亚低温治疗组的生存质量明显高于对照组。 结论 亚低温治疗可明显改善重度DAI的临床症状、BEAM及预后 ,在降低ICP、升高CPP的同时 ,降低急性期血ET ,改善脑血流动力学变化。
Objective To analyze the effect and mechanism of hypothermia (HT) treatment for severe diffuse axonal injury. Methods sixty five cases were treated with moderate HT group and thirty three cases with normal temperature (control group). Intracranial pressure (ICP), cranial perfusion pressure (CPP), brain electrical activity map (BEAM), endothelin (ET), transcranial ultrasonic Doppler (TCD) findings and prognosis (GOS) were observed both before and after moderate hypothermia treatment. Results In the treatment group, ICP, CCP, BEAM and outcome were improved after HT treatment with a significant difference compared with the control group. After hypothermia treatment, the average level of ET in the treatment group was reduced from (92.31±11.58) ng/L to (55.83±3.83) ng/L ( P <0.01). While in the control group. Records of MCA mean velocity (Vm) were reduced from (65.1±4.9) cm/s to (52.7± 4.3) cm/s ( P <0.01). A decrease was seen in MCA systolic velocity (Vs) and pulse index(PI) value with a significant difference ( P < 0.01 ). Conclusions HT treatment can decrease ICP, increase CCP and improve the clinical manifestation, BEAM and outcome of severe diffuse axonal injury patients by means of decreasing acute stage ET, improving the blood velocity of MCA and decreasing cerebral vascular resistance. HT treatment can reduce cerebral vascular spasms, cerebral ischemia and hypoxia.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2002年第7期415-417,共3页
Chinese Journal of Trauma
关键词
脑损伤
脑电描记术
内皮素
超声检查
亚低温
治疗
Brain injuries
Electroencephalography
Endothelin
Ultrosonography, Doppler, transcranial
Hypothermia
