摘要
目的研究亚低温治疗重型颅脑损伤过程中脑氧代谢和神经电生理变化规律,评估亚低温对重型脑伤的近期疗效。方法选择受伤后10 h 内入院 GCS(格拉斯哥昏迷评分,Glasgow ComaScale)3～8分之间的急性重型脑伤患者148例,按病情轻重分为 GCS 7～8分组、GCS 5～6分组和GCS 3～4分组,并随机分入亚低温亚组和常温亚组。亚低温亚组(32～34℃)在降温前后的不同时段记录脑氧代谢监测指标、神经电生理指标;常温组在同样的时段记录上述指标。结果 GCS 7～8分组:SLSEP 的 N20波幅、BAEP 的Ⅰ/Ⅴ波幅比值和 rSaO_2在降温后亚低温组较常温组有显著性改善,P_(br)O_2在亚低温组的部分时段低于常温组;GCS 5～6分组:亚低温治疗组 N20、Ⅰ/Ⅴ和 rSaO_2在部分时段较常温组有改善,P_(br)O_2在亚低温组的部分时段高于常温组;GCS 3～4分组:亚低温组与常温组上述指标均无显著性差异。结论亚低温对于 GCS 7～8分的重型脑伤有明显的治疗作用,对 GCS 3～4分者无明显疗效,对 GCS 5～6分者疗效不确定;脑氧代谢和神经电生理指标对颅脑损伤的疗效评价具有重要意义。
Objective To observe the changes of brain oxygen metabolism and neuroeletrophysiology after severe brain injury, and the effects of hypothermia on severe brain injury. Methods 148 patients with severe brain injury （GCS 3-8, admitted within 10 hours from injury） were selected for this study. Patients were divided into 3 groups, Group C, CS 7-8, Group GCS 5-6 and Group GCS 3-4. Every group were also randomly assigned to normothermia and hypothermia subgroup. Patients in the hypothermia group were cooled to 32-34℃. SLSEP, BAEP, PbrO2 and rSaO2 were recorded in each group at the same time. Results In the Group GCS 7-8, N20 in SLSEP, I/V in BAEP and rSaO2 were improved significantly after mild hypothermia treatment, and PbrO2 Was decreased by hypothermia; In the Group GCS 5-6, N20 in SLSEP, I/V in BAEP and rSaO2 were improved by hypothermia, and Pbr O2 Was decreased in hypothermia subgroup; In the Group GCS 3-4, no significant difference was found. Conclusion Mild hypothermia has a significant effect on patients of GCS 7-8 and a doubt effect on patients of GCS 5-6. It seem no effect on patients of GCS 3-4. Brain oxygen metabolism and neuroelectrophysiology are important to valuate the therapeutic effect on severe brain injury.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第2期109-113,共5页
Chinese Journal of Surgery
基金
重庆市卫生局科研指导基金(1997-2005)
关键词
脑损伤
亚低温
脑氧代谢
神经电生理
Brain injury
Mild hypothermia
Brain oxygen metabolism
Neuroelectrophysiology
作者简介
通讯作者：晏怡，Email：yanyi2005@gmail.com
