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目的探讨亚低温治疗对重型颅脑损伤(STBI)患者血清肿瘤坏死因子(TNF)和白细胞介素(IL)水平的影响。方法 52例STBI患者随机均分为两组:B组给予脱水、止血、抗炎及神经营养药物等常规治疗;A组加用亚低温治疗。定期进行电解质、血常规、血糖、血气分析、心肌酶谱及肝肾功能检查,严密监护体征。于治疗第1天、第7天和第14天采集肘静脉血5ml,用ELISA法检测血清TNF-α、IL-2、IL-6及IL-10水平。记录伤后6个月时的格拉斯哥预后分级(GOS)。结果治疗期间,A组血清IL-2和IL-10水平高于B组(P<0.01),而血清IL-6和TNF-α水平低于B组(P<0.01)。A组预后良好率和中残率均稍高于B组,而重残率、植物生存率和死亡率均稍低于B组(P>0.05)。结论创伤性脑损伤后,亚低温治疗可能通过抑制创伤后炎症反应和改善机体免疫状态达到脑保护作用。
Objective To investigate the effects of mild hypothermia on serum levels of tumor necrosis factor (TNF) and interleukin (IL) in patients with severe head injury (STBI). Methods Fifty-two patients with STBI were randomly divided into two groups: Group B was given conventional therapy such as dehydration, hemostasis, anti-inflammatory and neurotrophic drugs; Group A was treated with mild hypothermia. Regular electrolyte, blood, blood glucose, blood gas analysis, myocardial enzymes and liver and kidney function tests, closely monitor the signs. Five milliliters of elbow venous blood was collected on day 1, day 7 and day 14 of treatment. Serum levels of TNF-α, IL-2, IL-6 and IL-10 were measured by ELISA. Glasgow outcome grading (GOS) was recorded 6 months after injury. Results During the treatment, serum IL-2 and IL-10 levels in group A were significantly higher than those in group B (P <0.01), while serum IL-6 and TNF-α levels were lower in group A than those in group B (P <0.01). The good prognosis and the moderate morbidity in group A were slightly higher than those in group B, while the rates of severe disability, plant survival and mortality were slightly lower than those in group B (P> 0.05). Conclusion After traumatic brain injury, mild hypothermia may achieve cerebral protection by inhibiting post-traumatic inflammatory response and improving immune status.