重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

53例重型颅脑损伤长期昏迷病人的催醒效果

目的 介绍53例重型颅脑损伤持续昏迷1个月以上病人的催醒效果和影响催醒效果的因素。方法 伤后昏迷时间1～12个月、GCS≤8分的重型颅脑损伤病人53例，采用高压氧、理疗、药物等综合催醒方法治疗。结果 53例长期昏迷病人中，28例苏醒(52．8％)。按照GOS评分，28例清醒病人中仅6例恢复良好和中残(21．4％)，其他22例病人为重残、无自主生活能力(78．6％)。苏醒成功率与病人是否有原发性脑干伤、脑疝、GCS评分、年龄等冈素有关。结论 采用综合催醒方法，能提高长期昏迷病人苏醒成功率，但神绛功能恢复仍十分闲难。     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

微创引流术与开颅术治疗老年高血压脑出血病人疗效及对相关蛋白因子水平的影响

目的比较微创引流术与开颅术治疗老年高血压脑出血病人的疗效及对相关蛋白因子水平的影响。方法选取2015年3月至2017年3月我院收治的年龄60岁的老年高血压脑出血病人100例,随机分为对照组与观察组,每组50例。对照组实施开颅术,观察组实施微创引流术。观察并比较2组病人术后疗效、格拉斯哥预后评分(GOS)、术后血肿残余量及治疗前后Tau蛋白、胶质纤维酸性蛋白(GFAP)、N末端脑钠肽前体(NTpro BNP)水平的变化。结果手术后,对照组治疗总有效率为72. 00%,观察组为92. 00%,2组比较差异有统计学意义(P0. 05)。2组术后GOS评分与术前比较显著升高,术后血肿残余量、Tau蛋白、GFAP及NT-proBNP水平显著降低,差异均有统计学意义(P0. 05);且观察组较对照组改变更明显,组间比较差异有统计学意义(P0. 05)。结论微创引流术治疗老年高血压脑出血,可改善病人生活质量及再出血情况,降低相关蛋白因子水平,显著提高临床疗效。     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型高血压脑出血外科治疗探讨

目的探讨重型高血压脑出血外科治疗的方法。方法对166例重型高血压脑出血病人进行外科手术治疗,术后结合亚低温或轻度低温疗法,重视术后各种并发症并进行有效防治。结果166例中,26例死亡;存活病人中恢复良好105例,重残22例,植物生存13例,疗效满意。结论对重型高血压脑出血病人进行外科手术治疗后,采取亚低温或轻度低温治疗并重视术后并发症的防治,可取得良好疗效。     

外伤性迟发性颅内血肿的诊治体会

目的 探讨外伤性迟发性脑内血肿（DTICH）临床特点,以提高早期诊断和正确处理能力。方法 回顾性分析我院诊治的42例DTICH患者的病因、发生机制、血肿类型、部位、临床表现、诊断、治疗及结果。结果 康复起好26例,中残6例,重残4例,植物生存2例,死亡4例。结论 DTICH形成的原因多样。降低DTICH病死率和致残率的关键在于早期诊断和及时治疗。     

脑室出血病人术后轻度低温治疗的疗效观察

目的探讨应用轻度低温疗法对脑室出血术后病人的治疗效果。方法参考冬眠亚低温的治疗方法,对36例有脑室出血的病人,在术后采用轻度低温(35~36℃)进行脑保护,不中断呼吸,应用冬眠合剂I号等配合治疗。结果29例生存,轻残8例,中残12例,重残8例,植物生存1例,恢复良好率22.22%;7例死亡,死亡率19.44%。结论本方法较适合于基层医院或条件相对不足的医疗单位,仍然可取得良好效果。     

亚低温治疗重型颅脑损伤外周血WBC的变化及其临床意义

目的探讨外周血白细胞及中性粒细胞对亚低温治疗重型颅脑损伤的临床疗效评估。方法120例经手术治疗后的重型颅脑损伤患者,随机分为亚低温组和对照组。亚低温组于手术后予亚低温治疗,直肠温度降至33～35℃,对照组体温维持存36.5～37.5℃。共治疗3～7 d,分别于术后第1 d和第8 d对两组患者的外周血WBC及中性粒细胞进行检测和GCS进行评估,6个月后进行GOS预后评估。结果亚低温组和对照组在术后第1 d的GCS和WBC及中性粒细胞没有显著性差异,但到第8 d则表现出明显的差异性,亚低温组的GCS及WBC和中性粒细胞均优于对照组(P<0.01或P<0.05);随访6个月亚低温组GOS预后显著优于对照组(P<0.01)。结论亚低温是治疗重型颅脑损伤的有效手段之一,并且外周血WBC及中性粒细胞的变化是评估颅脑创病人预后的客观指标之一。