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目的比较全身亚低温与局部亚低温对于高血压性脑出血患者的临床疗效。方法将96例高血压性脑出血患者随机分为全身亚低温治疗组(30例)、局部亚低温治疗组(36例)和对照组(30例)。在给予脑出血常规治疗的同时,全身亚低温治疗组加用全身亚低温(电子冰毯)治疗,局部亚低温治疗组加用头颅局部亚低温(电子冰帽)治疗。观察脑内血肿体积、血肿周围水肿体积及神经功能缺失评分的变化。结果人组后7 d 各组的血肿体积、血肿周围水肿体积及神经功能缺失评分无显著性差异。入组后14 d 时,全身亚低温治疗组血肿体积(14.22±14.06 ml)较局部亚低温治疗组(20.54±16.41 ml)和对照组(22.26±13.20 ml)显著缩小(P<0.05);全身亚低温治疗组血肿周围水肿体积(16.25±12.31 ml)和局部亚低温治疗组(22.01±12.08ml)血肿周围水肿体积均与对照组(28.21±10.02 ml)相比,均有显著缩小(均为 P<0.01),而全身治疗组与局部治疗组相比亦有显著改善(P<0.01);入组后14 d 时全身治疗组与局部治疗组的神经功能缺失评分(分别为15.02±9.86分和20.15±10.02分)较对照组(26.18±11.26分)均有显著改善,而全身亚低温治疗组较局部亚低温治疗组亦有显著改善(P<0.01)。结论全身亚低温治疗及电子冰帽局部亚低温治疗均能促进高血压脑出血患者血肿周围水肿的消退,改善临床神经功能缺损。而全身亚低温还有减小血肿范围的作用,其促进血肿周围水肿的消退,改善临床神经功能缺损的作用要优于头颅局部亚低温治疗。
Objective To compare the clinical effects of systemic mild hypothermia with local mild hypothermia in patients with hypertensive intracerebral hemorrhage. Methods 96 patients with hypertensive intracerebral hemorrhage were randomly divided into systemic hypothermia treatment group (30 cases), local mild hypothermia treatment group (36 cases) and control group (30 cases). At the same time of routine treatment of intracerebral hemorrhage, the whole body hypothermia treatment group was treated with systemic hypothermia (electronic ice blanket), while the local mild hypothermia treatment group was treated with cranial local mild hypothermia (electronic ice cap). Changes in intracerebral hematoma volume, edema volume around hematoma, and neurological deficit scores were observed. Results There was no significant difference in the volume of hematoma, the volume of edema around hematoma and the score of neurological deficit in each group on the 7th day. The volume of hematoma (14.22 ± 14.06 ml) in the whole body mild hypothermia group was significantly smaller than that in the local mild hypothermia group (20.54 ± 16.41 ml) and the control group (22.26 ± 13.20 ml) on the 14th day after operation (P <0.05) Compared with the control group (28.21 ± 10.02 ml), the volume of edema around the hematoma in the mild hypothermia group (16.25 ± 12.31 ml) and the local mild hypothermia group (22.01 ± 12.08 ml) were significantly reduced (P <0.01), while the systemic treatment group also had a significant improvement compared with the local treatment group (P <0.01). On the 14th day after treatment, the neurological deficit scores of the systemic treatment group and the local treatment group were 15.02 ± 9.86 And 20.15 ± 10.02 points respectively) than the control group (26.18 ± 11.26 points), while the whole body mild hypothermia treatment group than the local mild hypothermia treatment group also significantly improved (P <0.01). Conclusion The whole body mild hypothermia treatment and electronic ice cap partial hypothermia treatment can promote hypertensive intracerebral hemorrhage in patients with hematoma subsided to improve clinical neurological deficits. The whole body mild hypothermia and reduce the role of hematoma range, promote the edema around the hematoma subsided to improve clinical neurological deficit better than the local cranial hypothermia treatment.