不同复温速度对重症颅脑外伤亚低温治疗患者脑血流、颅内压及神经功能的影响
|
摘要
目的探讨不同复温速度对重症颅脑外伤亚低温治疗患者脑血流、颅内压及神经功能的影响。方法方便选取该院2018年7—10月收治的行亚低温治疗的重症颅脑外伤患者90例作为研究对象。将患者按数字表法随机分为A组(n=30)、B组(n=30)和C组(n=30)。A组复温速度0.2℃/h、B组复温速度0.3℃/h及C组复温速度0.4℃/h。治疗过程中患者颅内压、心率、血压等进行动态监测;利用脑卒中临床神经功能缺损程度评分量表评价神经功能缺损情况;并在复温前、复温后12 h、24 h、48 h及72 h使用TCD监测大脑中动脉的收缩期峰流速率;并于伤后3个月根据格拉斯哥预后分级(GOS)对疗效进行评定。结果复温后A组HR(86.44±10.2)次/min、MAP(77.29±5.52)mmHg、ICP(12.22±4.31)mmHg及NIHSS(11.21±1.23)分变化情况均优于B组(78.48±10.23)次/min、(72.31±5.28)mmHg、(14.43±3.47)mm Hg、(12.72±2.11)分及C组(80.38±10.23)次/min、(70.22±5.19)、(15.53±3.28)mmHg、(12.64±2.21)分(P<0.05),而B组与C组两组相比差异无统计学意义(t=0.72,1.54,1.26,0.14,P>0.05);A组复温后24 h、48 h及72 h大脑中动脉收缩期峰流速率分别为(39.53±5.32)、(45.73±5.21)、(46.87±5.63)cm/s明显优于B组(36.32±3.53)、(42.53±4.27)、(43.43±4.24)cm/s及C组(36.42±3.25)、(42.42±4.3)、(42.42±4.31)cm/s (P<0.05);而B组与C组两组相比差异无统计学意义(t=0.11,0.09,0.91,P>0.05),A组的优良率73.33%稍高于B组66.67%及C组63.33%的优良率,但差异无统计学意义(χ~2=0.31、0.69,P>0.05)。结论对重症颅脑外伤亚低温治疗,较慢的复温速度可使脑灌注得到改善,脑水肿减轻,从而对神经功能起到保护作用,并改善患者预后。
Objective To investigate the effects of different rewarming speeds on cerebral blood flow, intracranial pressure and neurological function in patients with severe craniocerebral trauma. Methods 90 patients with severe craniocerebral trauma convenient treated by sub-hypothermia treated from July 2018 to October in the hospital were selected as subjects.Patients were randomly divided into group A(n=30), group B(n=30), and group C(n=30) according to the digital table method.The rewarming speed of group A was 0.2 °C/h, the rewarming speed of group B was 0.3 °C/h, and the rewarming speed of group C was 0.4 ° C/h. During the treatment, the intracranial pressure, heart rate and blood pressure of the patients were dynamically monitored. The neurological deficits were evaluated by the clinical neurological deficit degree scale of stroke;and used before rewarming, 12 h, 24 h, 48 h and 72 h after rewarming. TCD was used to monitor the systolic peak flow rate of the middle cerebral artery; the efficacy was assessed according to the Glasgow Prognostic Grading(GOS) 3 months after injury. Results After rewarming, the changes of HR(86.44±10.2) times/min, MAP(77.29±5.52)mmHg, ICP(12.22±4.31)mmHg and NIHSS(11.21±1.23)points in Group A were better than those in Group B(78.48±10.23)tmes/min,(72.31±5.28)mmHg,(14.43±3.47)mmHg,(12.72±2.11)min and C group(80.38±10.23)times/min,(70.22±5.19)mmHg,(15.53±3.28)mmHg,(12.64±2.21)times/min(P<0.05) and there was no significant difference between group B and group C(t=0.72,1.54,1.26,0.14,P>0.05);peak flow rate of cerebral artery systolic at 24 h, 48 h and 72 h after rewarming in group A was(39.53±5.32)cm/s,(45.73±5.21)cm/s and(46.87 ±5.63)cm/s, respectively, which was significantly better than group B(36.32 ±3.53)cm/s,(42.53 ±4.27)cm/s,(43.43±4.24)cm/s and C group(36.42±3.25)cm/s,(42.42±4.3)cm/s,(42.42±4.31)cm/s(P<0.05); and group B and group C had no significant difference between the two groups(t =0.11, 0.09, 0.91, P >0.05). The excellent and good rate of group A was 73.33%, which was slightly higher than that of group B of 66.67% and group C of 63.33%. There was no significant difference in statistics(χ~2=0.31, 0.69, P >0.05). Conclusion For mild hypothermia treatment of severe craniocerebral trauma, slower rewarming speed can improve brain perfusion and reduce brain edema, thereby protecting nerve function and improving patient prognosis.
Objective To investigate the effects of different rewarming speeds on cerebral blood flow, intracranial pressure and neurological function in patients with severe craniocerebral trauma. Methods 90 patients with severe craniocerebral trauma convenient treated by sub-hypothermia treated from July 2018 to October in the hospital were selected as subjects.Patients were randomly divided into group A(n=30), group B(n=30), and group C(n=30) according to the digital table method.The rewarming speed of group A was 0.2 °C/h, the rewarming speed of group B was 0.3 °C/h, and the rewarming speed of group C was 0.4 ° C/h. During the treatment, the intracranial pressure, heart rate and blood pressure of the patients were dynamically monitored. The neurological deficits were evaluated by the clinical neurological deficit degree scale of stroke;and used before rewarming, 12 h, 24 h, 48 h and 72 h after rewarming. TCD was used to monitor the systolic peak flow rate of the middle cerebral artery; the efficacy was assessed according to the Glasgow Prognostic Grading(GOS) 3 months after injury. Results After rewarming, the changes of HR(86.44±10.2) times/min, MAP(77.29±5.52)mmHg, ICP(12.22±4.31)mmHg and NIHSS(11.21±1.23)points in Group A were better than those in Group B(78.48±10.23)tmes/min,(72.31±5.28)mmHg,(14.43±3.47)mmHg,(12.72±2.11)min and C group(80.38±10.23)times/min,(70.22±5.19)mmHg,(15.53±3.28)mmHg,(12.64±2.21)times/min(P<0.05) and there was no significant difference between group B and group C(t=0.72,1.54,1.26,0.14,P>0.05);peak flow rate of cerebral artery systolic at 24 h, 48 h and 72 h after rewarming in group A was(39.53±5.32)cm/s,(45.73±5.21)cm/s and(46.87 ±5.63)cm/s, respectively, which was significantly better than group B(36.32 ±3.53)cm/s,(42.53 ±4.27)cm/s,(43.43±4.24)cm/s and C group(36.42±3.25)cm/s,(42.42±4.3)cm/s,(42.42±4.31)cm/s(P<0.05); and group B and group C had no significant difference between the two groups(t =0.11, 0.09, 0.91, P >0.05). The excellent and good rate of group A was 73.33%, which was slightly higher than that of group B of 66.67% and group C of 63.33%. There was no significant difference in statistics(χ~2=0.31, 0.69, P >0.05). Conclusion For mild hypothermia treatment of severe craniocerebral trauma, slower rewarming speed can improve brain perfusion and reduce brain edema, thereby protecting nerve function and improving patient prognosis.
引文
[1]孙宇,袁从华,吴良发.颅脑损伤术中出现急性脑膨出的原因及对策[J].中国实用神经疾病杂志,2014,17(9):39-40.
[2]朱进,杨平来,周立田.亚低温治疗重型颅脑损伤的临床分析[J].临床神经外科杂志,2013(6):360-361.
[3]何世花.亚低温护理对重症颅脑外伤患者神经功能损伤及血流动力学影响研究[J].中外医疗,2013,32(18):37-38.
[4]李华.亚低温护理用于重症颅脑外伤患者护理中的临床效果[J].健康之路,2017,3(12):157.
[5]史载祥,王晓猛,李茂琴,等.复温速度对重症颅脑外伤亚低温神经保护的初步研究[J].中华临床医师杂志:电子版,2014,8(2):46-49.
[6]陆镇奇,刘丽君,高平明.不同复温速度对亚低温治疗新生儿缺氧缺血性脑病的影响[J].分子影像学杂志,2016,1(3):241-244.
[7] Talaei F, Bouma HR, Van der Graaf AC, et al. Serot onin and dopamine protect from hypothermia/rewarming damage through the CBS/H2S pathway[J]. PLo S One, 2011,6:e22568.
[8] Sunde K. Rewarming after therapeutic hypothermia[J]. Resuscitation, 2012, 3(8):930-931.
[9]张民,李勤朴,冯晓奇.超低位去大骨瓣术联合亚低温治疗重型颅脑损伤的临床疗效[J].中国处方药,2015,13(11):6-7.
[10]敖勇,陈迎春,霍秀银,等.亚低温治疗对重型颅脑损伤患者颅内压、脑血流及氧代谢的影响[J].现代生物医学进展,2016(21):4128-4130.
[2]朱进,杨平来,周立田.亚低温治疗重型颅脑损伤的临床分析[J].临床神经外科杂志,2013(6):360-361.
[3]何世花.亚低温护理对重症颅脑外伤患者神经功能损伤及血流动力学影响研究[J].中外医疗,2013,32(18):37-38.
[4]李华.亚低温护理用于重症颅脑外伤患者护理中的临床效果[J].健康之路,2017,3(12):157.
[5]史载祥,王晓猛,李茂琴,等.复温速度对重症颅脑外伤亚低温神经保护的初步研究[J].中华临床医师杂志:电子版,2014,8(2):46-49.
[6]陆镇奇,刘丽君,高平明.不同复温速度对亚低温治疗新生儿缺氧缺血性脑病的影响[J].分子影像学杂志,2016,1(3):241-244.
[7] Talaei F, Bouma HR, Van der Graaf AC, et al. Serot onin and dopamine protect from hypothermia/rewarming damage through the CBS/H2S pathway[J]. PLo S One, 2011,6:e22568.
[8] Sunde K. Rewarming after therapeutic hypothermia[J]. Resuscitation, 2012, 3(8):930-931.
[9]张民,李勤朴,冯晓奇.超低位去大骨瓣术联合亚低温治疗重型颅脑损伤的临床疗效[J].中国处方药,2015,13(11):6-7.
[10]敖勇,陈迎春,霍秀银,等.亚低温治疗对重型颅脑损伤患者颅内压、脑血流及氧代谢的影响[J].现代生物医学进展,2016(21):4128-4130.