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目的评价阶梯式亚低温治疗单纯弥漫性轴突损伤(DAI)的疗效。方法对36例单纯DAI随机分为两组:亚低温组实施阶梯式亚低温治疗,在伤后6～12h内将膀胱温度(BT)降至32.0～33.9℃,持续3d,第4～7天BT控制在34.0～35.9℃,第8～14天在36.0～36.9℃;常规治疗组作为对照。监测颅内压、血脑脊液乳酸、昏迷时间,测量伤后第3个月CT片侧脑室额角宽度、第三脑室前后径,并对患者进行功能障碍(DRS)评分。结果与常规治疗组比较,时程为2周的阶梯式亚低温组明显降低颅内压、血脑脊液乳酸,减轻额角扩大,降低DRS(P<0.01或P<0.05),而不增加亚低温并发症发生率;但亚低温期间昏迷程度不减轻,也不缩短昏迷时间。结论阶梯式亚低温其并发症未增多,可减轻DAI损伤后的脑白质性脑萎缩,改善后期神经功能,但不能减轻DAI昏迷程度和缩短昏迷时间。
Objective To evaluate the therapeutic effect of stepped mild hypothermia on diffuse axonal injury (DAI). Methods Thirty-six patients with simple DAI were randomly divided into two groups. In the mild hypothermia group, stepwise mild hypothermia was performed. The bladder temperature (BT) was reduced to 32.0-33.9 ℃ within 6-12 hours after injury and continued for 3 days and 4-7 days BT control at 34.0 ~ 35.9 ℃, the first 8 to 14 days at 36.0 ~ 36.9 ℃; conventional treatment group as a control. The intracranial pressure, blood cerebrospinal fluid lactic acid and coma time were measured. The frontal width of lateral ventricle and the third ventricle were measured at the third month after injury, and the patients were evaluated for their disability (DRS). Results Compared with the conventional treatment group, the intracranial pressure and the blood cerebrospinal fluid lactate were significantly decreased in the step-and-step hypothermia group with a duration of 2 weeks, which reduced the DRS (P <0.01 or P <0.05) and did not increase the incidence of mild hypothermia The incidence of the disease; but mild hypothermia does not reduce the degree of coma, nor shorten the coma time. Conclusions The complications of step-type hypothermia are not increased. It can reduce the white matter-induced brain atrophy after DAI injury and improve the neurological function in late stage. However, it can not reduce the coma of DAI and shorten the coma.