亚低温对重型颅脑伤患者血清细胞因子的影响

目的 探讨亚低温治疗对重型颅脑损伤患者血清中肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-6、IL-8的影响及临床意义。方法 选择符合条件的重型颅脑损伤患者[格拉斯哥昏迷评分（GCS）3～8分]共23例，于伤后24h内行亚低温治疗，控制直肠温度33～35℃，持续5d；对照组20例（GCS3～8分）。采用酶联免疫吸附法（ELISA）监测两组患者外周血清TNF-α、IL-1β、IL-6、IL-8在伤后第1，2，3，4天的动态变化。结果 亚低温治疗组患者血清TNF-α、IL-1β、IL-6、IL-8浓度较常规治疗组明显降低（P〈0．05）。结论 亚低温通过降低重型颅脑损伤患者血清中细胞因子的水平，减少了患者多器官功能障碍综合征的发生。     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

目的 通过动态观察亚低温对急性重型颅脑损伤患者血清S-100B蛋白浓度的影响,探讨亚低温在急性重型颅脑损伤治疗中的作用.方法 将120例急性重型颅脑损伤患者随机数字表法分为亚低温组和常规组.亚低温组在常规治疗的基础上,予亚低温治疗,直肠温度维持在33～35℃,持续3～5 d.所有患者于入院6 h内,入院后第2,3,4,5,6天动态检测血清S-100B蛋白浓度.3个月后对患者进行GOS评估.结果 亚低温组和常规组血清S-100B蛋白浓度明显高于正常对照组(P<0.05);亚低温组血清S-100B蛋白浓度明显低于常规组(P<0.05);亚低温能够改善急性重型颅脑损伤患者的预后.结论 早期应用亚低温能显著降低急性重型颅脑损伤患者血清S-100B蛋白浓度,保护神经功能,改善预后,其脑保护作用可能与亚低温能减轻S-100B蛋白介导的损伤性脑细胞炎症反应有关.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温对急性重型颅脑损伤患者血清S-100 B蛋白的影响

Objective To dynamically observe the effect of mild hypothermia on concentration of plasma S-100B protein in patients with acute severe brain injuries so as to further explore its role in treat-ment of acute severe brain injury. Methods A total of 120 patients with acute severe brain injuries were randomly divided into mild hypothermia group and general group. The patients in mild hypothermia group were treated with mild hypothermia besides conventional therapy, with maintenance of rectal tem-perature at 33℃-35℃ for 3-5 days. Serial concentration of S-IOOB protein in serum was measured in all patients from 6 hours to 6 days after hospitalization. GOS evaluation was done three months after treat-ment. Results The concentration of S-100B protein in serum of mild hypothermia group and general group was significantly higher than of normal group (P <0.05), with significant lower level in mild hypo-thermia group than general group(P <0.05). Mild hypothermia could improve prognosis of patients with acute severe brain injury. Conclusions Early use of mild hypothermia can decrease concentration of S-100B protein in serum, protect neurofunction and improve prognosis, as may be related to its function in alleviating damnification brain cell inflammation reaction mediated by S-100B protein.     

亚低温治疗对降低重型颅脑损伤患者颅内压的作用

急性脑水肿是颅脑损伤最常见的病理改变，易导致脑疝形成，危及患者生命，或造成中枢神经功能的严重损害从而影响患者生存质量。因此，治疗急性脑水肿在神经外科显得极为重要。笔者使用亚低温(32～35℃)治疗重型颅脑损伤患者，通过监测颅内压，评估亚低温治疗急性脑水肿的效果。     

亚低温治疗对重型颅脑损伤脑脊液乳酸及酸碱平衡的影响

目的　对重型颅脑损伤患者在亚低温治疗过程中的脑脊液PO2 、PCO2 、pH值、乳酸水平及动脉血pH值进行监测分析 ,探讨亚低温治疗对重型颅脑损伤脑脊液酸碱平衡的影响。方法　收集 4 2例重型颅脑伤 (GCS≤ 8分 )患者 ,平均年龄 4 1 .7岁。亚低温组于伤后 1 2小时内实施亚低温治疗 (32～ 34℃ ) ,时程 3～ 5天 ;对照组给予常规治疗。两组均于降温前、降温 2 4、4 8、72小时各时段测定脑脊液PO2 、PCO2 、pH值、乳酸水平及动脉血pH值 ,并进行统计学分析。结果　脑温及体温的变化对血pH值影响不大。血pH值大致波动在正常范围 ,而脑脊液pH值始终低于正常。各时段的脑脊液pH值均明显低于血pH值 (P <0 .0 5 )。亚低温组和对照组在降温前时段 ,脑脊液PO2 、PCO2 、乳酸水平无显著性差异 (P >0 .0 5 ) ;降温 2 4、4 8、72小时时段 ,亚低温组脑脊液PO2 、PCO2 、乳酸水平明显低于对照组。结论　亚低温治疗在降低重型颅脑损伤 (GCS≤ 8分 )患者脑脊液PO2 的同时 ,也降低了脑脊液PCO2 、乳酸水平 ,但不能改善脑脊液的低pH值状态     

选择性脑亚低温治疗重型颅脑损伤

目的　比较选择性脑亚低温与全身亚低温治疗重型颅脑损伤的治疗效果。方法　将 6 9例重型颅脑损伤 (GCS≤ 8分 )患者分成 3组 :(1 )选择性脑亚低温组 2 3例 ,头部局部降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(2 )全身亚低温组 2 2例 ,全身降温 ,将脑温降至 33～ 35℃ ,治疗 3～ 5日 ;(3)常温对照组 2 4例 ,予常规治疗。结果　选择性脑亚低温组预后良好率为 5 6 .5 % (1 3/ 2 3) ,病死率 2 1 .7% (5 / 2 3) ,与全身亚低温组相仿 [分别为 5 4 .5 % (1 2 / 2 2 )和 2 2 .7% (5 / 2 2 ) ],与对照组比较 (良好率 2 5 % ,病死率 4 5 .8% ) ,有显著差异(P <0 .0 5 )。全身组与对照组总并发症发生率比较无显著差异 (P >0 .0 5 ) ,而选择性脑亚低温组总并发症发生率明显低于全身组与对照组 (P <0 .0 1 )。结论　选择性脑亚低温对重型颅脑损伤的疗效与全身亚低温相仿 ,明显优于常温对照组 ,是目前治疗重型颅脑损伤安全而有效的方法之一。     

亚低温对重型颅脑伤患者血糖和糖代谢相关激素水平的影响

目的　研究亚低温治疗对重型颅脑损伤患者糖代谢相关激素的影响及其意义。　方法　亚低温治疗组选择符合条件的重型颅脑损伤患者（GCS3～8分）共24例,于伤后24h内行亚低温治疗,控制直肠温度33～35℃,持续3～5d;对照组21例（GCS3～8分）。两组患者伤后急性期（＜48h）清晨空腹抽取静脉血标本,采用放射免疫分析法检测血清中胰岛素、皮质醇及生长激素含量。　结果　对照组患者血糖值为(10.25±4.18)mmol/L,皮质醇为(424.67±125.85)ng/L;亚低温组患者血糖值为(8.40±3.75)mmo/L,皮质醇为(290.71±110.50)ng/L,两组比较差异均有显著性意义（P＜0.01）。两组患者胰岛素和生长激素无明显变化。　结论　亚低温治疗能够减轻糖代谢相关激素紊乱,降低高血糖,改善预后。     

亚低温治疗急性重型颅脑损伤的临床研究

目的 研究亚低温对重型脑损伤病人生命体征、颅内压（ＩＣＰ）,血超氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）、ＰａＯ２及ＰａＣＯ２变化的影响。     

亚低温治疗重型颅脑损伤的护理体会

90年代以来 ,临床研究结果发现 ,30℃～ 33℃亚低温能显著降低重型颅脑伤患者的死亡率 ,改善颅脑伤患者神经功能和预后 ,不产生严重并发症。 36例重型颅脑伤病人 ,其中 2 3例经亚低温治疗 ,取得显著疗效 ,护理工作取得了一些经验 ,现总结如下。1　临床资料与方法1.1　一般资料　 36例重型颅脑损伤 (ＧＣＳ≤ 7分 )男性 32例 ,女性 14例 ,年龄 2 0～ 10 5岁 ,平均年龄 6 2 5岁 ,膜膜外血肿 10例 ,硬膜下血肿 12例 ,弥散性血肿 9例 ,原发性脑干损伤 1例 ,脑室出血 4例。 2 3例经亚低温治疗 ,死亡 4例(17 3% )。 13例未经亚低温治疗 ,死亡 7例…     

亚低温治疗重型颅脑损伤的Meta分析

目的探讨亚低温治疗重型颅脑损伤的临床治疗效果。方法按照系统评价的要求全面检索万方全文数据库（数字化期刊和学位论文数据库）、维普中文科技期刊全文数据库、中国知网及CBMdisk，对符合纳入标准的15个随机对照研究共计1606例患者预后进行Meta分析。结果失安全系数m=147，发表性偏倚对Meta分析结果的影响较小。异质性检验，15个随机对照研究之间具有高度同质性（P=0．96，0．88，I^2=0％），可用固定效应模型进行分析。合并分析结果显示：亚低温组与对照组比较，疗效差异有统计学意义，亚低温组预后良好率显著优于对照组（P〈0．01），死亡率显著低于对照组（P〈0．01）。结论从本组临床证据来看，亚低温治疗重型颅脑损伤效果较好，但尚需要严格设计的、大样本的随机双盲对照试验来进一步验证和支持。     

亚低温对重型颅脑损伤后脑循环动力学的影响

目的 研究亚低温对重型颅脑损伤（ＳＨＩ）后脑循环动力学的影响及其临床意义。方法 ３６例ＳＨＩ患者,随机分为常规治疗组和亚低温组,各１８例。用脑循环动力学检测仪检测伤后０,１,３,７,１０,１４,２１ｄ的脑循环动力学指标（ＣＶＤＩ）,结合ＣＴ动态观察,分析两组ＣＶＤＩ变化规律、伤灶脑水肿大小和预后。结果 与正常组比较,常规治疗组伤后ＣＶＤＩ可划分为四个期,即低灌注期（０ｄ）、高灌注期（１￣３ｄ）、脑