亚低温治疗对脑出血所致MODS的影响

魏亮; 王琦; 杨成; 张燕飞; 管宏新; 孙志扬

亚低温治疗对脑出血所致MODS的影响

同济大学附属上海市东方医院神经外科

基金项目:

基金：上海市浦东新区卫生和计划生育委员会面上基金资助项目(PW2014A-15); 上海市卫计委面上基金资助项目(201440319);

计量
- 文章访问数: 1491
- HTML全文浏览量: 555
- PDF下载量: 42
- 被引次数: 0
出版历程
- 收稿日期: 2016-09-16

The Effects of Mild Hypothermia on MODS Caused by Cerebral Hemorrhage

Funds:

基金：上海市浦东新区卫生和计划生育委员会面上基金资助项目(PW2014A-15); 上海市卫计委面上基金资助项目(201440319);

摘要

摘要: 目的分析全身亚低温治疗对脑出血所致MODS的影响及全身亚低温技术的临床价值.方法选取同济大学附属上海市东方医院重症监护室于2012年1月至2015年12月收住院的脑出血后并发MODS患者180例,随机分为观察组和对照组,对照组采用常温(normothermic,NT)治疗,观察组采用全身亚低温治疗(whole body mild hypothermia,WHT)治疗,观察对比2组患者治疗后的MODS评分、氧耗(oxygen consumption,VO2)与氧供(oxygen delivery,DO2)比值、ICU住院时间、机械通气时间、癫痫发生率及病死率、卒中量表评分和巴氏指数评分.结果观察组患者经治疗后MODS评分、氧耗与氧供状况均显著优于对照组,差异有统计学意义(P<0.05);观察组患者症状ICU住院时间和机械通气时间和对照组相比更短,差异有统计学意义(P<0.05);观察组患者经治疗后的癫痫发生率和病死率均显著少于对照组,差异有统计学意义(P<0.05);观察组患者的卒中量表评分和巴氏指数评分均显著优于对照组患者,差异有统计学意义(P<0.05).结论全身亚低温技术对于脑出血所致MODS有着重要的临床意义,可以有效改善MODS患者的氧供需平衡,延缓MODS患者病情的进展,改善预后,值得在临床中应用推广.
- 脑出血 /
- 多器官功能障碍综合征 /
- 亚低温
Abstract: Objective To disscuss and analyze the clinical effects of whole body mild hypothermia on MODS caused by cerebral hemorrhage.Methods One hundred and eighty patients with MODS caused by cerebral hemorrhage during the period of hospitalized from January 2013 to December 2015 in ICU of our hospital were divided into two groups(observation group and control group) randomly,90 cases patients in each group.Patients in control group were treated with conventional treatment intervention,patients in control group were treated with whole body mild hypothermia on the base of conventional treatment intervention,the score of MODS,the ratio of,VO2 and DO2, the time during the period of hospitalized in ICU, the time of mechanical ventilation, epilepsy incidence and mortality, NIHSS score and PADL score of the patients in these two group after treatment were compared.Results After the comparion,the score of MODS and the state of oxygen consumption and oxygen supply of the patients in observation group were better than the patients in control group, there was significant differences,and had statistical significance(P<0.05);the time during the period of hospitalized in ICU and the time of mechanical ventilation of the patients in observation group were shorter than the patients in control group,there was significant difference,and had statistical significance(P<0.05);the mortality were reduce significantly of the patients in observation group than the patients in control group,there was significant difference,and had statistical significance(P<0.05);the epilepsy incidence of the patients in observation group and control has no significant difference,has no statistical significance(P>0.05);the NIHSS score and PADL score of the patients in observation group were higher than the patients in control group, there was significant difference, and has statistical significance(P<0.05).Conclusion The clinical effects of whole body mild hypothermia on MODS caused by cerebral hemorrhage have important significance,can effectively improve the balance of multiple organ dysfunction syndrome patients,can delay the progression of multiple organ dysfunction syndrome patients, improve the prognosis,it is worthy of clinical application and promotion.
- Cerebral hemorrhage /
- Multiple organ dysfunction syndrome /
- Mild hypothermia

HTML全文

参考文献(15)

[1]李萍,赵树明,胡亚男,等.脑出血发病机制研究进展[J].中华老年心脑血管病杂志,2015,2(17):214-216.
[2]	[2]ZHANG C,LEE Y Y,KEEP R F,et al.Brain cdema formation and complement activation in a rat model of subarachnoid hemorrhage[J].Acta Neurochir Suppl,2013:1(118):157-161.
[3]陈以胜,赵明亮,梁海乾,等.亚低温后脑损伤组织提取液对体外脐带间充质干细胞的影响[J].中华创伤杂志,2016,1(32):80-83.
[4]于垚,高旭光.去铁胺治疗脑出血的研究进展[J].中华临床医师杂志(电子版),2014,9(8):1722-1726.
[5]文明,丛明,张振兴.微创与开颅手术在脑出血治疗中的疗效及安全性比较[J].中华神经外科疾病研究杂志,2014,13(4):90-363.
[6]李致文,吴丽娥.脑出血急性期的血压调控[J].中华老年心脑血管病杂志,2013,10(15):115-1118.
[7]杨中良,杨秀云,郭梅凤,等.老年脑出血昏迷患者继发MODS的危险因素分析[J].中华老年心脑血管病杂志,2013,8(15):835-838.
[8]王超,苏强,张淑文,等.多器官功能障碍综合征诊断标准的多中心临床研究[J].中华外科杂志,2009,47(1):40-45.
[9]	[9]YENARI M A,HAN H S.Neuroprotective mechanisms of hypothermia in brain ischemia[J].Nat Rev Neurosci,2012,13(4):267-268.
[10]	[10]KONSTANINIDIS A,INADA K,DUBOSE J,et al.The impact of nontherapeutic hypothermia on outcomes after severe traumatic brain injury[J].J Trauma,2011,71(118):1627-1631.
[11]	[11]SHANKARAN S,PAPPAS A,MCDONALD SA,et al.Childhood outcomes after hypothermia for neonatal encephalopathy[J].N Engl J Med,2012,366(22):2085-2092.
[12]李萍,赵建军,赵树明.活血化瘀法治疗脑出血的实验研究进展[J].中华老年心脑血管病杂志,2012,10(14):1117-1119.
[13]于湘友,李娜.连续性血液净化治疗多器官功能障碍综合征疗效分析[J].中华肾脏病杂志,2011,4(27):235-238.
[14]肖红艳,许卫江,刘彬,等.亚低温血液净化技术在心脏瓣膜病术后心源性休克治疗中的应用[J].中国急救医学,2015,9(35):836-838.
[15]	[15]TU Y,CHEN C,SUN H T,et al.Combination of temperature sensitive stem cells and mild hypothermia:a new potenial therapy for severe traumatic brain injury[J].J Neurotrauma,2012,29(14):2393-2403.

相关文章(20)

[1]	黄毅, 黄永健, 麦玲, 罗婷. 动脉瘤性蛛网膜下腔出血患者TGF-β/Smads信号转导通路与认知功能障碍的关系, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240319
[2]	汪鑫邦, 胡安, 赵喜鹏, 汪炎, 丁伟, 操礼鹏, 古禹, 许轲, 张云峰. Ommaya囊治疗脑出血并发急性期脑积水疗效及对血脑屏障功能的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20241015
[3]	李孔龙, 陈晶, 赵玲, 舒筠然, 柯亭羽. 阻塞性睡眠呼吸暂停低通气综合征与亚临床甲减的相关性, 昆明医科大学学报.
[4]	保玉莲, 朱榆红, 李勤, 鲍天昊. 脑出血患者血清MicroRNA-124的表达及临床相关因素, 昆明医科大学学报.
[5]	湛自兰. 护理干预对脑出血非手术患者心理状态、并发症以及满意度的影响, 昆明医科大学学报.
[6]	王丹. 血清低密度脂蛋白胆固醇水平与脑出血的相关性初探, 昆明医科大学学报.
[7]	刘乐万. 钻孔穿刺引流术治疗高血压脑出血的临床应用研究, 昆明医科大学学报.
[8]	倪忠梅. 高血压脑出血患者焦虑、抑郁状态的护理干预, 昆明医科大学学报.
[9]	黄微. 脑出血与脑梗死并发腹泻发生率的临床研究, 昆明医科大学学报.
[10]	高莉萍. 高血压性脑出血微创手术与保守治疗的临床疗效对比分析, 昆明医科大学学报.
[11]	吴丽珍. 急性低温暴露对家兔心肝肾功能的影响, 昆明医科大学学报.
[12]	张蕾. 微创穿刺治疗高血压性脑出血112例临床分析, 昆明医科大学学报.
[13]	董建平. 神经外科患者气管切开治疗53例临床分析, 昆明医科大学学报.
[14]	刘泽飞. 额部钻孔置管引流术治疗高血压性脑出血, 昆明医科大学学报.
[15]	赵晓红. 代谢综合征与轻度认知功能障碍的临床研究, 昆明医科大学学报.
[16]	郭昌贵. 依达拉奉治疗急性脑出血的临床疗效观察, 昆明医科大学学报.
[17]	. 高血压脑出血合并糖尿病的术式选择及围手术期处理, 昆明医科大学学报.
[18]	廉坤. 外伤性脑梗的亚低温114例临床治疗分析, 昆明医科大学学报.
[19]	. 脑选择性深低温研究进展, 昆明医科大学学报.
[20]	庄永辉. 微创尿激酶引流治疗高血压脑出血, 昆明医科大学学报.