亚低温治疗急性脑梗死不同起始时间的近期及远期预后观察

目的：研究全身亚低温不同起始时间对急性脑梗死近期与远期预后的影响，以进一步探讨亚低温治疗最佳时间窗。方法对急性大面积脑梗死患者117例，随机分为亚低温治疗组6～12 h 时（A1）22例及12～24 h（A2）32例；对照组6～12 h （B1）30例及12～24 h（B2）33例。对照组予常规抗血小板、降脂稳定斑块、改善循环、脑保护及对症治疗，亚低温治疗组在常规治疗的基础上采用全身亚低温治疗，配合冬眠合剂。使肛温控制在33～35℃。降温持续时间5～7 d 。评定治疗前、治疗后第7、14天、1、3、6个月各时间点 NIHSS 评分、MRS 评分。并记录死亡、再发脑梗死等终点事件。结果①起始时间6～12 h与12～24 h 亚低温治疗组的近期疗效与远期疗效均优于各自对照组。②6～12 h 亚低温组近期与远期疗效均优于12～24 h亚低温组。③肺部感染是亚低温治疗较常见并发症，但可降低急性脑梗死患者应激性溃疡、脑心综合征的并发症。结论24 h 内长程亚低温治疗急性脑梗死可改善神经功能，降低致残率，且越早效果越好。

Obseration of the short-dated and long-dated effect of mild hypothermia therapy in different starting time on patients with acute cerebral infaction

Objective To observe the short‐dated and long‐dated effect of mild hypothermia therapy in different begining time on patients with acute cerebral infaction .Methods 117 patients with acute large area cerebral infarction patients ,according to starting time randomly divided into the mild hypothermia treatment group as 6 ~ 12 hours group (A1) 22 cases ;12 ~ 24 hours group(A2) 32 cases ;in control group as 6 ~ 12 hours group(B1) 30 cases and 33 cases of 12 ~ 24 hours group(B2) .Control group with antiplatelet ,stable plaques ,improve circulation ,brain protection treatment .Mild hypothermia treatment group was implementing 33 ~ 35 ℃ mild hypothermia therapy with hibernate medicines besides the basis of treatment .Duration of 5 ~ 7 days .Evaluation before the treatment and after the treatment of 7 days ,14 days ,1 month ,3 months ,half year with NIHSS score and MRS score .Results ① group A1 is superior to control group B1 .group A2 is superior to control group B2 ② group A1 is superior to group A2 ③ the lung infection is common complication ,but there was no statistically significant difference compared with control group .Conclusion 24 hours long‐term mild hypothermia therapy on acute cerebral infarction can improve nerve function ,reduce the mortality rate ,and the sooner the better .