Objective:To investigate the effect of long-term mild hypothermia therapy on coagulation system,oxidative stress injury and levels of inflammatory factors in patients with severe craniocerebral injury.Methods:130 cases of patients with severe craniocerebral injury were divided into group A (long-term mild hypothermia group,n =48),group B (short-term mild hypothermia group,n =44)and group C (normothermia group,n =38).All groups received basic treatment and corresponding therapy for severe craniocerebral injury.The changes of fibrinogen (Fbg) and D-dimer (D-D) levels,coagulation indexes such as prothrombin time (PT),thrombin time (TT) and activated partial thromboplastin time (APTT) in the three groups before treatment and 8,12,24,28 h after treatment were recorded.The changes of oxidative stress injury indexes such as nitric oxide (NO),superoxide dismutase (SOD) and malondialdehyde (MDA) before treatment and 1,3,5 d after treatment and at rewarming were statistically analyzed.The levels of C reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor α (TNF-α) and neuron specific enolase (NSE) were determined before treat-ment and 1,3,5 d after treatment and at rewarming.Results:After 8 h and 12 h of treatment,Fbg and D-D were increased,while PT,TT and APTT were shortened in the three groups.After 48 h and 72 h of treatment,Fbg and D-D were decreased,while PT,TT and APTT were prolonged (P ＜0.05).After 1 d,3 d,5 d of treatment,NO,SOD,MDA,CRP,IL-6,TNF-α and NSE decreased in three groups (P＜0.05),and NO,SOD,MDA,CRP,IL-6,TNF-α and NSE decreased in group A and group B at rewarming,the changes of NO,SOD,MDA in group A and group B were more significant than those in group C,the change of NO in group A were more significant than that group B.The incidence of hyperfibrinolysis and cerebral infarction in group A and group B was lower than group C (P ＜ 0.05).There was no significant difference in the incidence rate of other complications (P ＜ 0.05).Within 3 months' follow-up,The excellent and good rate of prognosis of group A was higher than that of group B and group C (P ＜ 0.05).Conclusion:The auxiliary application of long-term mild hypothermia therapy can alleviate hypercoagulable state in patients with severe craniocerebral injury after operation,inhibit hyperfibrinolysis,relieve oxidative stress injury and the degree of inflammatory reactions,and optimize the prognosis.%目的:探讨长时程亚低温疗法对重型颅脑损伤患者术后部分凝血功能指标、氧化应激指标及炎性因子水平的影响.方法:130例重型颅脑损伤术后患者,按术后治疗方式分为长时程组(长时程亚低温治疗,n=48)、短时程组(短时程亚低温治疗,n=44)及常温组(常温治疗,n=38),3组均在接受重型颅脑损伤基础治疗基础上给予相应治疗,比较3组治疗前和治疗后8、12、48及72 h时纤维蛋白原(Fbg)、D-二聚体(D-D)水平及凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT),比较治疗前和治疗第1、3及5天和复温时一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA),比较治疗前和治疗后第3及5天和复温时C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及神经元特异性烯醇化酶(NSE)水平,随访3月评价预后.结果:与治疗前比较,治疗8、12 h时,3组患者Fbg、D-D上升,PT、TT、APTT缩短,Fbg、D-D降低,PT、TT、APTT延长(P＜0.05);与治疗前比较,3组在治疗第1、3及5天时,NO、SOD、MDA、CRP、IL-6、TNF-α及NSE水平均降低(P＜0.05);长短时程两组复温时,NO、SOD、MDA、CRP、IL-6、TNF-α及NSE水平也较治疗前均降低(P＜0.05);治疗第1、3及5天时,长短时程两组NO、SOD及MDA降低幅度高于常温组(P＜0.05),长时程组NO降低幅度又高于短时程组(P＜0.05);长短时程两组纤溶亢进和脑梗死发生率低于常温组(P＜0.05),其余各并发症发生率比较差异无统计学意义(P＞0.05);术后3月随访结果显示,长时程组预后良好所占比例高于短时程组和常温组(P＜0.05).结论:重型颅脑损伤患者术后应用长时程亚低温疗法可减轻患者血液高凝状态,抑制纤溶亢进,改善患者氧化应激损伤,减轻炎症反应程度,优化其预后.
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