Treatment of traumatic brain injury with moderate hypothermia
Treatment of traumatic brain injury with moderate hypothermia
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DOI：
10.1056/nejm199702203360803
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发表时间：
1997-02-20
影响因子：
158.5
通讯作者：
DeKosky, ST
中科院分区：
文献类型：
--
作者：
Marion, DW;Penrod, LE;DeKosky, ST
背景创伤性脑损伤启动了几个代谢过程，可以加重损伤。有证据表明，低温可能会限制这些有害的代谢responses.Methods在一项随机对照试验中，我们比较了中度低温和常温的影响，在82例严重闭合头juries（评分为3至7分的格拉斯哥昏迷量表）。被分配到低温组的患者在受伤后平均10小时被冷却到33摄氏度，在32到33摄氏度保持24小时，然后重新加热。物理医学和康复专家谁是不知道的治疗分配评估患者3，6和12个月后，使用的格拉斯哥Outcome Scale.Results的人口统计学特征和原因和损伤的严重程度是相似的低温和normothemia组。在12个月时，62%的低温组患者和38%的常温组患者有良好的结局（中度，轻度或无残疾）。低体温组不良结局的校正风险比为0.5（95%置信区间为0.2至1.2）。对于入院时昏迷评分为3或4分的患者，低温并不能改善其预后。在评分为5 - 7分的患者中，低体温与3个月和6个月时显著改善的结局相关（不良结局的调整风险比为0.2;两个时间段的95%置信区间为0.1至0.9），尽管不是在12个月时（风险比，0.3; 95%的置信区间，0.1至1.0）结论重型颅脑损伤患者入院时昏迷评分为5 ~ 7分，亚低温治疗24 h可促进神经功能恢复可能会改善治疗效果(C)1997年，马萨诸塞州医学会。
Background Traumatic brain injury initiates several metabolic processes that can exacerbate the injury. There is evidence that hypothermia may limit some of these deleterious metabolic responses.Methods In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in 82 patients with severe closed head in juries (a score of 3 to 7 on the Glasgow Coma Scale). The patients assigned to hypothermia were cooled to 33 degrees C a mean of 10 hours after injury, kept at 32 to 33 degrees C for 24 hours, and then rewarmed. A specialist in physical medicine and rehabilitation who was unaware of the treatment assignments evaluated the patients 3, 6, and 12 months later with the use of the Glasgow Outcome Scale.Results The demographic characteristics and causes and severity of injury were similar in the hypothermia and normothermia groups. At 12 months, 62 percent of the patients in the hypothermia group and 38 percent of those in the normothermia group had good outcomes (moderate, mild, or no disabilities). The adjusted risk ratio for a bad outcome in the hypothermia group was 0.5 (95 percent confidence interval, 0.2 to 1.2). Hypothermia did not improve the outcomes in the patients with coma scores of 3 or 4 on admission. Among the patients with scores of 5 to 7, hypothermia was associated with significantly improved outcomes at 3 and 6 months (adjusted risk ratio for a bad outcome, 0.2; 95 percent confidence interval, 0.1 to 0.9 at both intervals), although not at 12 months (risk ratio, 0.3; 95 percent confidence interval, 0.1 to 1.0).Conclusions Treatment with moderate hypothermia for 24 hours in patients with severe traumatic brain injury and coma scores of 5 to 7 on admission hastened neurologic recovery and may have improved the outcome. (C) 1997, Massachusetts Medical Society.