Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury
Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury
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DOI：
10.1038/sj.jcbfm.9600253
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发表时间：
2006-06-01
影响因子：
6.3
通讯作者：
Luo, QZ
中科院分区：
文献类型：
--
作者：
Jiang, JY;Xu, W;Luo, QZ
目的比较长期亚低温与短期亚低温对215例重型颅脑损伤合并脑挫伤合并颅内高压患者预后的影响。在三个医疗中心，215例年龄在18至45岁之间，入院时格拉斯哥昏迷评分为1cm的患者通过计算机断层扫描确诊。格拉斯哥结局量表随访6个月，长期亚低温组预后良好47例（43.5%），预后不良61例（56.5%）。而短期亚低温组预后良好者仅31例（29.0%），预后不良者76例（71.0%），差异有统计学意义（P < 0.05）。短期亚低温组颅内压复温后明显回升，而长期亚低温组无明显回升（P < 0.05）。应激性溃疡、癫痫、肺部感染、颅内感染发生率两组比较差异无统计学意义（P < 0.05）。与短期亚低温治疗相比，长期亚低温治疗可显著改善重型颅脑损伤合并脑挫伤、颅内高压患者的预后，且无明显并发症。我们的数据表明，当应用亚低温控制重型颅脑损伤患者顽固性颅内高压时，5天的长期降温比2天的短期降温更有效。
To compare the effect of long-term mild hypothermia versus short-term mild hypothermia on the outcome of 215 severe traumatic brain injured patients with cerebral contusion and intracranial hypertension. At three medical centers, 215 patients aged 18 to 45 years old with an admission Glasgow Coma Scale 1cm confirmed on computed tomographic scan. Glasgow Outcome Scale at 6-month follow-up, 47 cases had favorable outcome (43.5%), and other 61 cases had unfavorable outcome (56.5%) in the long-term mild hypothermia group. However, only 31 cases had favorable outcome (29.0%), and other 76 cases had unfavorable outcome (71.0%) in the short-term mild hypothermia group (P < 0.05). The intracranial pressure significantly rebounded after rewarming in the short-term mild hypothermia group, but not in the long-term mild hypothermia ( P < 0.05). Furthermore, the incidence of stress ulcer, epilepsy, pulmonary infection, intracranial infection did not significantly differ between the two groups (P > 0.05). Compared with short-term mild hypothermia, long-term mild hypothermia significantly improves the outcome of severe traumatic brain injured patients with cerebral contusion and intracranial hypertension without significant complications. Our data suggest that 5 days of long-term cooling is more efficacious than 2 days of short-term cooling when mild hypothermia is used to control refractory intracranial hypertension in patients with severe traumatic brain injury.