CAJ | 학술논문

目的分析冰盐水联合冰帽与冰毯的亚低温疗法对重症脑卒中和颅脑外伤患者的临床疗效及神经功能的恢复作用,为亚低温治疗方案的临床应用提供可靠的临床资料.方法收集重症脑卒中和颅脑损伤(格拉斯哥昏迷评分GCS≤8分)患者84例,为脑出血、脑梗死、颅脑外伤三种常见并且脑损伤致脑功能异常(GCS≤8分)的疾病,发病均在12 h以内.脑出血、脑梗死均为高血压性脑血管病变,排除合并心、肝、肾、血液及其他病变.颅脑外伤排除伴胸、腹、四肢等其他器官复合伤患者.按入院时间段分为对照组和观察组,每组42例.2组均给予保持呼吸道通畅、预防感染、脱水、降低颅内压以及胞二磷胆碱、脑复康、神经节苷脂钠等常规治疗,对照组采用联合冰帽和冰毯的亚低温疗法,观察组采用冰盐水联合冰帽和冰毯的亚低温疗法.对患者入院时进行GCS评分和6个月时分别进行神经系统GCS评分与格拉斯哥预后评分(GOS评分),并对治疗12个月后的生活质量采用KPS评分进行评估.结果发病至开始亚低温治疗的时间及开始实施亚低温至目标低温的时间,观察组为(8±4)h和(3±1)h,对照组为(16±5)h和(6±2)h,2组比较差异均有统计学意义(P＜0.05).观察组和对照组患者6个月时的G CS评分分别是(7.01±1.12)和(4.02±1.11),观察组明显优于对照组(P＜0.05)；根据GOS评分将患者6个月时的神经系统评分分为良好、中残及不良,观察组GOS评分良好明显优于对照组(P＜0.05),中残组的差异无统计学意义(P＞0.05),不良观察组GOS评分明显次于对照组(P＜0.05).治疗12个月后评估生活质量(KPS评分),观察组的远期生活质量明显优于对照组(P＜0.05).结论对重症脑卒中和颅脑外伤患者采用冰盐水联合冰帽和冰毯的亚低温疗法,较采用单纯冰帽与冰毯的亚低温疗法,具有更好的脑保护作用.
목적 분석빙염수연합빙모여빙담적아저온요법대중증뇌졸중화로뇌외상환자적림상료효급신경공능적회복작용,위아저온치료방안적림상응용제공가고적림상자료.방법 수집중증뇌졸중화로뇌손상(격랍사가혼미평분GCS≤8분)환자84례,위뇌출혈、뇌경사、로뇌외상삼충상견병차뇌손상치뇌공능이상(GCS≤8분)적질병,발병균재12 h이내.뇌출혈、뇌경사균위고혈압성뇌혈관병변,배제합병심、간、신、혈액급기타병변.로뇌외상배제반흉、복、사지등기타기관복합상환자.안입원시간단분위대조조화관찰조,매조42례.2조균급여보지호흡도통창、예방감염、탈수、강저로내압이급포이린담감、뇌복강、신경절감지납등상규치료,대조조채용연합빙모화빙담적아저온요법,관찰조채용빙염수연합빙모화빙담적아저온요법.대환자입원시진행GCS평분화6개월시분별진행신경계통GCS평분여격랍사가예후평분(GOS평분),병대치료12개월후적생활질량채용KPS평분진행평고.결과 발병지개시아저온치료적시간급개시실시아저온지목표저온적시간,관찰조위(8±4)h화(3±1)h,대조조위(16±5)h화(6±2)h,2조비교차이균유통계학의의(P＜0.05).관찰조화대조조환자6개월시적G CS평분분별시(7.01±1.12)화(4.02±1.11),관찰조명현우우대조조(P＜0.05)；근거GOS평분장환자6개월시적신경계통평분분위량호、중잔급불량,관찰조GOS평분량호명현우우대조조(P＜0.05),중잔조적차이무통계학의의(P＞0.05),불량관찰조GOS평분명현차우대조조(P＜0.05).치료12개월후평고생활질량(KPS평분),관찰조적원기생활질량명현우우대조조(P＜0.05).결론 대중증뇌졸중화로뇌외상환자채용빙염수연합빙모화빙담적아저온요법,교채용단순빙모여빙담적아저온요법,구유경호적뇌보호작용.
Objective To study the moderate hypothermia with iced saline given intravenously with ice cap and ice sheet used in patients with severe stroke or craniocerebral trauma in order to clarify its clinical therapeutic effect and recovery of neurologic function for providing reliable clinical data.Methods A total of 84 patients suffered severe stroke (cerebral hemorrhage or cerebral infarction) or traumatic brain injury with GCS (Glascow Coma Scale) ＜8 admitted within 24 hours after onset were enrolled for study.The exclusion criteria were functional decompemsation of heart,liver,kidney and lung as cardiovascular complications of hypertension,hematological and other diseases,and craniocerebral trauma with multiple injuries of thorax,abdomen and extremities.Patients were divided into observation group and control group (n =42 in each group).The patients of two groups were managed to maintain respiratory tract patent,prevention of infection,dehydration,reduction of intracranial pressure and treated with Cytidine Diphosphate Choline,piracetam,ganglioside sodium and other conventional therapy.In control group,patients treated with ice cap and ice sheet,whereas in observation group,patients were treated with iced saline injected intravenously in addition to ice cap and sheet.At admission,the GCS score of patients was assessed and 6 months later,GCS score and Glascow Outcome Scale,(GOS) score of patients were determined,and 12 months after the treatment,quality of life score were evaluated by KPS.Results The time from onset of stroke or from trauma accident occurred to initiation of hypothermia treatment and time from initiation of hypothermia therapy to the target temperature reached in observation group were (8 ±4) hours and (3± 1 )hours respectively,and in control group,they were ( 16± 5) hours and (6 ± 2) hours,and there were significant differences between two groups ( P ＜ 0.05 ).The mean GCS score of patients at 6 months in the observation group and in the control group were (7.01 ± 1.12) and (4.02 ± 1.11 ) respectively (P ＜0.05 ) ; whereas the GOS score at 6 mouths of patients was categorized into good outcome,disabled outcome and poor outcome,and the good outcome in the observation group was significantly better than that in the control group (P ＜ 0.05 ),and no statistically significant difference in disabled outcome was found between two groups (P ＞ 0.05),and the poor outcome of GOS score was significantly lower in observation group than that in control group ( P ＜0.05 ).Twelve months after the treatment,the long-term quality of patients'life assessed by KPS score in observation group was significantly better than that in control group ( P ＜ 0.05).Conclusions The moderate hypothermia therapy by using iced saline administered intravenously combined with ice cap and ice sheet for severe stroke and head trauma patients conferred better therapeutic effects than the treatment with ice cap and ice sheet.