术中颈内动脉选择性脑局部控制性浅低温对脑出血患者脑保护的临床研究
|
摘要
目的探讨术中颈内动脉选择性脑局部控制性浅低温对脑出血患者的脑保护作用。方法选择2017年6月至2018年6月因高血压和外伤导致的,在杭州市富阳区第一人民医院实施开颅血肿清除术的脑出血患者40例。采用随机数字表法将患者分为两组,每组20例。研究组在术中对颈内动脉进行选择性脑局部浅低温处理,对照组一般常规治疗。观察两组患者术中出血量,术后1、24、48、72、96 h,5 d及6 d颅内压值,并评价两组患者术前及术后10 d的日常生活能力(activity of daily living, ADL)评分。结果研究组术中出血量为(305.33±107.36)ml,明显少于对照组[(390.67±119.85)ml,P<0.05];术后各时间点的颅内压值比较,研究组均低于对照组(P<0.05);研究组术后10 d的ADL评分为(67.52±10.43)分,明显高于对照组[(60.84±9.72)分],差异有统计学意义(P<0.05)。结论术中进行颈内动脉选择性脑局部控制性浅低温治疗可减少术中出血,降低术后颅内压,起到脑保护的作用。
Objective To explore the protective effect of selective local controlled mild hypothermia of internal carotid artery for the patients with intracerebral hemorrhage(ICH). Methods Forty patients with ICH were selected as subjects. Patients in the study group underwent selective local controlled mild hypothermia of the internal carotid artery during surgery,the control group was generally treated routinely. The volume of intraoperative blood loss and the intracranial pressure at 1,24, 48, 72, 96 h, 5 d and 6 d were evaluated, and the activity of daily living(ADL) scores of preoperative and postoperative10 d were evaluated. Results The volume of intraoperative bleeding in the study group was(305.33±107.36) ml, which was significantly less than that in the control group [(390.67 ± 119.85)ml, P<0.05]. And the intracranial pressures at each time point after surgery in the study group were significantly lower than those in the control group(P<0.05). The ADL score of the study group was(67.52±10.43) at 10 d after operation, which was significantly higher than that of the control group(60.84±9.72, P<0.05). Conclusions The selective local controlled mild hypothermia therapy of internal carotid artery can reduce intraoperative bleeding, intracranial pressure after operation, and play a protective role in the brain.
Objective To explore the protective effect of selective local controlled mild hypothermia of internal carotid artery for the patients with intracerebral hemorrhage(ICH). Methods Forty patients with ICH were selected as subjects. Patients in the study group underwent selective local controlled mild hypothermia of the internal carotid artery during surgery,the control group was generally treated routinely. The volume of intraoperative blood loss and the intracranial pressure at 1,24, 48, 72, 96 h, 5 d and 6 d were evaluated, and the activity of daily living(ADL) scores of preoperative and postoperative10 d were evaluated. Results The volume of intraoperative bleeding in the study group was(305.33±107.36) ml, which was significantly less than that in the control group [(390.67 ± 119.85)ml, P<0.05]. And the intracranial pressures at each time point after surgery in the study group were significantly lower than those in the control group(P<0.05). The ADL score of the study group was(67.52±10.43) at 10 d after operation, which was significantly higher than that of the control group(60.84±9.72, P<0.05). Conclusions The selective local controlled mild hypothermia therapy of internal carotid artery can reduce intraoperative bleeding, intracranial pressure after operation, and play a protective role in the brain.
引文
[1] An SJ, Kim TJ, Yoon BW. Epidemiology,risk factors,and clinical features of intracerebral hemorrhage:an update[J]. J Stroke, 2017, 19:3-10.
[2]刘贝,聂超然,田肇隆,等.体外循环低温条件下冠状动脉旁路移植术中IOC2镇痛监测的临床应用评价[J].北京医学, 2018, 40:517-519.
[3]赵杰,陈怀龙,马福国,等.浅低温对脑缺血再灌注小鼠海马蛋白激酶R样内质网激酶活性的影响[J].中华麻醉学杂志, 2016, 36:250-252.
[4] Lee JH, Ling W, Gu X, et al. Improved therapeutic benefits by combining physical cooling with pharmacological hypothermia after severe stroke in rats[J]. Stroke, 2016, 47:1907-1913.
[5]牛宏涛,杨小华,曹雯,等.不同时相亚低温治疗对心室纤颤兔脑功能的影响[J].中华急诊医学杂志, 2018, 27:44-50.
[6]高莉萍,李敏,刘虎军.综合护理干预对微创术治疗高血压性脑出血患者的影响[J].北京医学, 2018, 40:713-714.
[7]崔晓,景治涛,王运杰.大量脑出血手术患者的气管切开时机研究[J].空军医学杂志,2017,33:63-65.
[8]赵明明,赵阳阳,莫小樱,等.高血压性脑出血病理生理研究进展[J].中国卫生标准管理, 2018, 9:106-108.
[9] Lee JH, Zhang J, Yu SP. Neuroprotective mechanisms and translational potential of therapeutic hypothermia in the treatment of ischemic stroke[J]. Neural Regen Res, 2017, 12:341-350.
[10] Chen J, Liu L, Zhang H, et al. Endovascular hypothermia in acute ischemic stroke:a pilot study of selective intra-arterial cold saline infusion[J]. Stroke, 2016, 47:1933-1935.
[11]严浩,李贝.院外亚低温治疗与心肺复苏同时进行抢救心脏骤停患者的临床效果分析[J].北京医学, 2015, 37:1089-1091.
[12] Mcadams RM, Juul SE. Neonatal encephalopathy:update on therapeutic hypothermia and other novel therapeutics[J]. Clin Perinatol, 2016,43:485-500.
[13] Zhang Z, Zhang L, Ding Y, et al. Effects of therapeutic hypothermia combined with other neuroprotective strategies on ischemic stroke:review of evidence[J]. Aging Dis, 2018, 9:507-522.
[14]王晓锋,罗一峰,秦峥,等.兔颈内动脉选择性脑低温对急性局灶性脑缺血后脑水肿及脑灌注压的影响[J].中华神经医学杂志,2013, 12:1005-1010.
[15] Kurasako T, Zhao L, Pulsinelli WA, et al. Transient cooling during early reperfusion attenuates delayed edema and infarct progression in the spontaneously hypertensive rat.Distribution and time course of regional brain temperature change in a model of postischemic hypothermic protection[J]. J Cereb Blood Flow Metab, 2007, 27:1919-1930.
[2]刘贝,聂超然,田肇隆,等.体外循环低温条件下冠状动脉旁路移植术中IOC2镇痛监测的临床应用评价[J].北京医学, 2018, 40:517-519.
[3]赵杰,陈怀龙,马福国,等.浅低温对脑缺血再灌注小鼠海马蛋白激酶R样内质网激酶活性的影响[J].中华麻醉学杂志, 2016, 36:250-252.
[4] Lee JH, Ling W, Gu X, et al. Improved therapeutic benefits by combining physical cooling with pharmacological hypothermia after severe stroke in rats[J]. Stroke, 2016, 47:1907-1913.
[5]牛宏涛,杨小华,曹雯,等.不同时相亚低温治疗对心室纤颤兔脑功能的影响[J].中华急诊医学杂志, 2018, 27:44-50.
[6]高莉萍,李敏,刘虎军.综合护理干预对微创术治疗高血压性脑出血患者的影响[J].北京医学, 2018, 40:713-714.
[7]崔晓,景治涛,王运杰.大量脑出血手术患者的气管切开时机研究[J].空军医学杂志,2017,33:63-65.
[8]赵明明,赵阳阳,莫小樱,等.高血压性脑出血病理生理研究进展[J].中国卫生标准管理, 2018, 9:106-108.
[9] Lee JH, Zhang J, Yu SP. Neuroprotective mechanisms and translational potential of therapeutic hypothermia in the treatment of ischemic stroke[J]. Neural Regen Res, 2017, 12:341-350.
[10] Chen J, Liu L, Zhang H, et al. Endovascular hypothermia in acute ischemic stroke:a pilot study of selective intra-arterial cold saline infusion[J]. Stroke, 2016, 47:1933-1935.
[11]严浩,李贝.院外亚低温治疗与心肺复苏同时进行抢救心脏骤停患者的临床效果分析[J].北京医学, 2015, 37:1089-1091.
[12] Mcadams RM, Juul SE. Neonatal encephalopathy:update on therapeutic hypothermia and other novel therapeutics[J]. Clin Perinatol, 2016,43:485-500.
[13] Zhang Z, Zhang L, Ding Y, et al. Effects of therapeutic hypothermia combined with other neuroprotective strategies on ischemic stroke:review of evidence[J]. Aging Dis, 2018, 9:507-522.
[14]王晓锋,罗一峰,秦峥,等.兔颈内动脉选择性脑低温对急性局灶性脑缺血后脑水肿及脑灌注压的影响[J].中华神经医学杂志,2013, 12:1005-1010.
[15] Kurasako T, Zhao L, Pulsinelli WA, et al. Transient cooling during early reperfusion attenuates delayed edema and infarct progression in the spontaneously hypertensive rat.Distribution and time course of regional brain temperature change in a model of postischemic hypothermic protection[J]. J Cereb Blood Flow Metab, 2007, 27:1919-1930.