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目的探讨亚低温(MHT)联合机械通气治疗对急性重度颅脑损伤(TBI)患者神经功能及血流动力学的影响。方法选取2015年8月至2016年11月收治的急性重度TBI患者90例,入院后均采取标准大骨瓣减压术进行治疗,根据术后治疗方式分为对照组和实验组,每组45例,对照组于术后6 h内进行早期气管插管机械通气,实验组在对照组的基础上联合MHT治疗。于治疗前后检测两组患者神经功能因子及血流动力学指标水平变化,采用Barthel指数积分、美国国立卫生研究院卒中量表(NIHSS)、精神状态评价量表(MMSE)评价两组治疗后神经功能恢复情况。结果治疗后两组神经胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S-100B)、髓鞘碱性蛋白(MBP)均较治疗前下降(P<0.05,P<0.01),且实验组低于对照组(P<0.05,P<0.01)。治疗后两组平均血流速度(Vmean)、最大血流速度(V_(max))、最小血流速度(V_(min))、平均血流量(Qmean)均较治疗前上升,脑血管阻力(R)较治疗前下降(P<0.05,P<0.01),两组治疗后差异有统计学意义(P<0.05,P<0.01)。治疗后两组Barthel指数、MMSE评分显著高于治疗前,NIHSS评分显著低于治疗前(P均<0.01),实验组NIHSS评分显著高于对照组(P<0.05),其他评分组间比较无统计学差异(P>0.05)。结论 MHT联合机械通气治疗急性重度TBI疗效确切,可明显改善脑部血供状况,促进机体神经功能的恢复,对患者预后发挥重要作用。
Objective To investigate the effects of mild hypothermia (MHT) combined with mechanical ventilation on neurological function and hemodynamics in patients with acute severe traumatic brain injury (TBI). Methods Ninety patients with acute severe TBI admitted from August 2015 to November 2016 were selected and treated with standard decompressive craniectomy after admission. According to the postoperative treatment, they were divided into control group and experimental group, with 45 In the control group, mechanical ventilation of early tracheal intubation was performed within 6 hours after operation. The experimental group was treated with MHT on the basis of the control group. Before and after treatment, the neurological function and hemodynamic indexes of two groups were detected. Barthel index, NIHSS and MMSE were used to evaluate the neurological deficits Functional recovery. Results After treatment, glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE), S100B protein (S-100B), and myelin basic protein (MBP) 0.05, P <0.01), and the experimental group was lower than the control group (P <0.05, P <0.01). After treatment, the average blood flow velocity (Vmean), maximum blood flow velocity (V max), minimum blood flow velocity (V min) and mean blood flow (Qmean) (P <0.05, P <0.01). There was significant difference between the two groups after treatment (P <0.05, P <0.01). After treatment, Barthel index and MMSE score of the two groups were significantly higher than those before treatment, NIHSS score was significantly lower than before treatment (P <0.01), NIHSS score of the experimental group was significantly higher than that of the control group (P <0.05) Statistical difference (P> 0.05). Conclusion MHT combined with mechanical ventilation is effective in treating acute severe TBI. It can obviously improve blood supply to the brain and promote the recovery of nerve function, which plays an important role in the prognosis of patients.