中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
2期
220-223
,共4页
史载祥%王晓猛%李茂琴%李家琼%许艳军%李琳%莫逊
史載祥%王曉猛%李茂琴%李傢瓊%許豔軍%李琳%莫遜
사재상%왕효맹%리무금%리가경%허염군%리림%막손
颅内压%复温%脑损伤%危重病
顱內壓%複溫%腦損傷%危重病
로내압%복온%뇌손상%위중병
Intracranial pressure%Rewarming%Brain injuries%Critical illness
目的：探讨不同复温速度对重症颅脑外伤亚低温神经保护作用的影响。方法将39例亚低温治疗的重症颅脑外伤患者随机分为Ⅰ组（n＝13，复温速度0.1℃/h）、Ⅱ组（n＝13，复温速度0.2℃/h）及Ⅲ组（n＝13，复温速度0.3℃/h）。治疗过程中动态监测颅内压、心率、血压、脉氧饱和度，每日测定血糖、血细胞分析、血气分析、凝血功能、肝肾功能、电解质，每日进行GCS评分，并于伤后3个月根据格拉斯哥预后分级（GOS）评定疗效。结果复温达36.5℃时及达标后24 hⅢ组颅内压监测（ICP）明显高于Ⅰ组，有统计学意义（P＜0.05）；复温达标后72 h GCSⅠ组、Ⅱ组均高于Ⅲ组，有统计学意义（P＜0.05），Ⅰ组高于Ⅱ组，但无统计学意义；3个月时Ⅰ组、Ⅱ组GOS明显优于Ⅲ组（P＜0.05）,Ⅰ组与Ⅱ组间比较无明显差异；复温达36.5℃时及达标后24 hⅢ组血糖明显高于Ⅰ组和Ⅱ组，差异有统计学意义（P＜0.05）。结论较慢的复温速度可改善脑灌注，减轻脑水肿，有效保护神经功能并改善预后。
目的：探討不同複溫速度對重癥顱腦外傷亞低溫神經保護作用的影響。方法將39例亞低溫治療的重癥顱腦外傷患者隨機分為Ⅰ組（n＝13，複溫速度0.1℃/h）、Ⅱ組（n＝13，複溫速度0.2℃/h）及Ⅲ組（n＝13，複溫速度0.3℃/h）。治療過程中動態鑑測顱內壓、心率、血壓、脈氧飽和度，每日測定血糖、血細胞分析、血氣分析、凝血功能、肝腎功能、電解質，每日進行GCS評分，併于傷後3箇月根據格拉斯哥預後分級（GOS）評定療效。結果複溫達36.5℃時及達標後24 hⅢ組顱內壓鑑測（ICP）明顯高于Ⅰ組，有統計學意義（P＜0.05）；複溫達標後72 h GCSⅠ組、Ⅱ組均高于Ⅲ組，有統計學意義（P＜0.05），Ⅰ組高于Ⅱ組，但無統計學意義；3箇月時Ⅰ組、Ⅱ組GOS明顯優于Ⅲ組（P＜0.05）,Ⅰ組與Ⅱ組間比較無明顯差異；複溫達36.5℃時及達標後24 hⅢ組血糖明顯高于Ⅰ組和Ⅱ組，差異有統計學意義（P＜0.05）。結論較慢的複溫速度可改善腦灌註，減輕腦水腫，有效保護神經功能併改善預後。
목적：탐토불동복온속도대중증로뇌외상아저온신경보호작용적영향。방법장39례아저온치료적중증로뇌외상환자수궤분위Ⅰ조（n＝13，복온속도0.1℃/h）、Ⅱ조（n＝13，복온속도0.2℃/h）급Ⅲ조（n＝13，복온속도0.3℃/h）。치료과정중동태감측로내압、심솔、혈압、맥양포화도，매일측정혈당、혈세포분석、혈기분석、응혈공능、간신공능、전해질，매일진행GCS평분，병우상후3개월근거격랍사가예후분급（GOS）평정료효。결과복온체36.5℃시급체표후24 hⅢ조로내압감측（ICP）명현고우Ⅰ조，유통계학의의（P＜0.05）；복온체표후72 h GCSⅠ조、Ⅱ조균고우Ⅲ조，유통계학의의（P＜0.05），Ⅰ조고우Ⅱ조，단무통계학의의；3개월시Ⅰ조、Ⅱ조GOS명현우우Ⅲ조（P＜0.05）,Ⅰ조여Ⅱ조간비교무명현차이；복온체36.5℃시급체표후24 hⅢ조혈당명현고우Ⅰ조화Ⅱ조，차이유통계학의의（P＜0.05）。결론교만적복온속도가개선뇌관주，감경뇌수종，유효보호신경공능병개선예후。
Objective To explore the effects of the rate of rewarming during hypothermia therapy on neuroprotective in patients with severe traumatic brain injury. Methods 39 cases of severe traumatic brain injury were randomly divided into group I (n=13, rewarming rate of 0.1℃/h), II group (n=13, rewarming rate of 0.2℃/h) and G roup III (n=13, rewarming rate of 0.3℃/h) during hypothermia therapy. Intracranial pressure, heart rate, blood pressure, pulse oximetry were continuously monitored. Blood glucose, blood cell analysis, blood gas analysis, coagulation, liver and kidney function, electrolytes were measured daily. GCS score was assessed daily. GOS (Glasgow Outcome Classification ) was evaluated at 3 months after injury. Results ICP in group III was significantly higher than that in group I at points of rewarming to 36.5℃and 24 hours after rewarming to 36.5℃(P<0.05). Compared with group III, GCS were improved in group I and II at 72 hours after rewarm(P<0.05). GOS in Group I, II group were significantly better than that in group III (P<0.05) at 3 months after hypothermia therapy. However, there was no significant difference in GOS between I and II group. Blood glucose in group III was significantly higher than those in group I and II at points of rewarming to 36.5 ℃ and 24 hours after rewarming to 36.5℃(P<0.05). Conclusions Cerebral edema and cerebral perfusion can be improved by slower rewarming rate. Also, neurological function and the prognosis improved.
