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血管内低温治疗对重型颅脑损伤标准大骨瓣减压术后患者颅内压及脑血流动力学的影响
Effects of intravascular hypothermia on intracranial pressure and cerebral hemodynamics in patients with severe traumatic brain injury after standard decompression craniectomy
- 陆军军医大学学报 2022年44卷第13期 页码：1307-1313
- 作者机构：
1.400016 重庆，重庆医科大学护理学院
2.400014 重庆, 重庆市急救医疗中心神经外科
- 作者简介：
[牟绍玉，E-mail：643163877@qq.com MU Shaoyu, E-mail: 643163877@qq.com
- 基金信息：重庆市科卫联合医学科研项目(2022MSXM111)
DOI：10.16016/j.2097-0927.202201030
中图分类号： R454.5;R619;R651.15收稿：2022-01-05，
修回：2022-03-05，
纸质出版：2022-07-15
- 稿件说明：
移动端阅览
高英, 廖利萍, 何琦, 等. 血管内低温治疗对重型颅脑损伤标准大骨瓣减压术后患者颅内压及脑血流动力学的影响[J]. 陆军军医大学学报, 2022,44(13):1307-1313.
Ying GAO, Liping LIAO, Qi HE, et al. Effects of intravascular hypothermia on intracranial pressure and cerebral hemodynamics in patients with severe traumatic brain injury after standard decompression craniectomy[J]. Journal of Army Medical University, 2022, 44(13): 1307-1313.
高英, 廖利萍, 何琦, 等. 血管内低温治疗对重型颅脑损伤标准大骨瓣减压术后患者颅内压及脑血流动力学的影响[J]. 陆军军医大学学报, 2022,44(13):1307-1313. DOI： 10.16016/j.2097-0927.202201030.
Ying GAO, Liping LIAO, Qi HE, et al. Effects of intravascular hypothermia on intracranial pressure and cerebral hemodynamics in patients with severe traumatic brain injury after standard decompression craniectomy[J]. Journal of Army Medical University, 2022, 44(13): 1307-1313. DOI： 10.16016/j.2097-0927.202201030.
摘要
目的
2
探讨血管内低温治疗对重型颅脑损伤(severe traumatic brain injury
sTBI)标准大骨瓣减压术后患者颅内压及脑血流动力学的影响。
方法
2
采用回顾性队列研究，收集2019年1月至2021年3月在重庆市急救医疗中心接受标准大骨瓣减压术后颅内压(intracranial pressure
ICP)>20 mmHg的82例重型颅脑损伤患者临床资料，根据术后是否实施血管内低温治疗分组，分析血管内低温治疗对两组患者ICP、脑血流动力学水平、脑损伤标志物含量等差异的影响，采用格拉斯哥预后评分描述预后。
结果
2
共82例患者纳入研究，其中实施低温治疗38例为实验组，未实施低温治疗44例为对照组。实验组实施低温治疗后ICP开始下降，于12 h后降至20 mmHg以下；对照组术后ICP波动幅度大，于18 h后ICP降至20 mmHg以下。术后22、24 h，实验组ICP较对照组降低更明显(
P
<
0.05)；术后1周脑血流动力学水平: 两组大脑中动脉收缩期峰值血流速度、平均血流速度均较术前上升，实验组较对照组上升更明显(
P
<
0.05)；两组搏动指数均较术前降低，实验组较对照组降低更明显(
P
<
0.05)；术后1周脑损伤标志物含量: 两组角质纤维酸性蛋白、S-100β蛋白、神经元特异性烯醇化酶均较治疗前降低，且实验组降低更明显(
P
<
0.05)；术后6个月实验组预后良好22例(57.90%)，对照组预后良好15例(34.09%)，两组比较差异有统计学意义(
P
=0.042)。
结论
2
血管内低温治疗可降低sTBI标准大骨瓣减压术后患者ICP，改善脑血流动力学。
Abstract
Objective
2
To investigate the effects of intravascular hypothermia on intracranial pressure (ICP) and cerebral hemodynamics in patients with severe traumatic brain injury (sTBI) after standard decompression craniectomy.
Methods
2
A retrospective cohort study was carried out on 82 sTBI patients admitted to Chongqing Emergency Medical Center from January 2019 to March 2021. All patients received standard decompressive craniectomy (ICP>20 mmHg). Among them
38 patients were treated with intravascular hypothermia as the experimental group
and 44 patients were not as the control group. The effects of intravascular hypothermia on ICP
cerebral hemodynamics
and brain injury markers were analyzed
and the results were compared between the 2 groups. Glasgow coma scale was used to evaluate the prognosis.
Results
2
ICP in the experimental group began to decrease after hypothermia treatment
and decreased to less than 20 mmHg in 12 h later. In the control group
ICP fluctuated greatly
and decreased to below 20 mmHg in 18 h later. At 22 and 24 h after operation
ICP was more significantly decreased in the experimental group than the control group (
P
<
0.05). At 1 week after operation
the peak systolic blood flow velocity and average blood flow velocity of middle cerebral artery were increased
the pulsatile index was decreased
the serum contents of glial fibrillary acidic protein
S-100β and neuron-specific enolase were decreased in the 2 groups. And above changes were more obviously in the experimental group than the control group (all
P
<
0.05). In 6 months after operation
22 cases (57.90%) in the experimental group and 15 cases (34.09%) in the control group achieved a good prognosis
with significant difference between them (
P
=0.042).
Conclusion
2
Intravascular hypothermia can reduce ICP and improve cerebral hemodynamics in sTBI patients after standard decompression craniectomy.
关键词
Keywords
references
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