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目的探究亚低温治疗重型颅脑损伤对临床疗效及治疗后并发症的影响。方法选择2014年8月至2016年2月徐州市中心医院收治的伤后24 h内的急性重型颅脑损伤90例患者作为研究对象,按随机数字表法分为观察组和对照组,每组45例。对照组患者给予常规治疗,观察组患者给予亚低温治疗。观察两组患者治疗前、治疗后1 d及治疗后3 d的血糖、血乳酸、颅内压(ICP)水平的变化,比较两组患者治疗期间的生命体征、血气、血电解质及并发症的发生情况,并在伤后6个月根据格拉斯哥预后评分(GOS)评估两组患者的预后及恢复情况。结果与治疗前比较,两组患者治疗后1 d及治疗后3 d的血糖及血乳酸均明显降低(P均<0.05),且观察组患者的血糖及血乳酸水平明显低于对照组(P均<0.05)。与治疗前比较,观察组患者治疗1 d后ICP明显降低(P<0.05),对照组患者治疗3 d后ICP明显降低(P<0.05),观察组患者治疗后1 d及治疗后3 d的ICP均明显低于对照组(P均<0.05);伤后6个月GOS评分判定观察组患者预后良好率为62.2%(28/45),对照组预后良好率为37.8%(19/45),两组比较差异具有统计学意义(P<0.05)。观察组患者治疗开始后的心率逐渐下降,当患者体温恢复至31.5~34.9℃时患者的心率降至正常范围,治疗后3 d内对照组患者的心率持续高于正常水平。治疗过程中观察组有3例患者出现轻微的低钾血症,经补钾后逐渐恢复。结论亚低温应用于临床治疗重型颅脑损伤患者安全有效,预后情况良好。
Objective To investigate the effect of mild hypothermia on the treatment of severe craniocerebral injury and its clinical effects. Methods Ninety patients with acute severe craniocerebral injury within 24 hours after injury admitted to Xuzhou Central Hospital from August 2014 to February 2016 were selected as subjects and divided into observation group and control group according to random number table method. 45 cases. Patients in the control group were given conventional therapy and patients in the observation group were treated with mild hypothermia. The changes of blood glucose, blood lactate and intracranial pressure (ICP) before treatment, 1 d after treatment and 3 d after treatment were observed. The vital signs, blood gas, blood electrolytes and complications during the treatment were compared between the two groups And the prognosis and recovery of the two groups were evaluated according to the Glasgow Outcome Scale (GOS) 6 months after the injury. Results Compared with those before treatment, the blood glucose and blood lactic acid of the two groups were significantly decreased on the first day and the third day after treatment (P <0.05), and the levels of blood glucose and blood lactate in the observation group were significantly lower than those in the control group All <0.05). Compared with those before treatment, ICP decreased significantly (P <0.05) in the observation group 1 day after treatment, ICP decreased significantly in the control group 3 days after treatment (P <0.05), and in the observation group 1 d after treatment and 3 d after the treatment ICP was significantly lower than that of the control group (P <0.05). The GOS score at 6 months after injury was 62.2% (28/45) in the observation group and 37.8% (19/45) in the control group , The difference between the two groups was statistically significant (P <0.05). In the observation group, the heart rate gradually decreased after the start of treatment. When the body temperature recovered to 31.5 ~ 34.9 ℃, the heart rate of the patients dropped to the normal range. The heart rate of the control group continued to be higher than the normal level within 3 days after the treatment. During the course of treatment, 3 patients in the observation group had mild hypokalemia and gradually recovered after potassium supplement. Conclusions Mild hypothermia is safe and effective in clinical treatment of patients with severe traumatic brain injury. The prognosis is good.