亚低温对大动脉闭塞性脑卒中动脉溶栓后早期神经功能恶化的影响

摘要

Objective To explore effects of mild hypothermia on early neurological deterioration (END) after main arterial occlusive with intra-arterial thrombolysis. Methods Fifty patients were randomly divided into mild hypothermia and conventional group, to compared the changes of ICP, CVP, MAP, Blood K+, PT, PLT, ScvO2 and NIHSS before- treatment and 24 h and 7 d after- treatment , prognosis and mortality were evaluated by MRS after 90 d. Results (1) Compared with pre-treatment, 7 d NIHSS of mild hypothermia group decreased (P < 0.01); 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05); 24 h decreased significantly (P <0.05), while 7 d blood K+ showed no differences. (2) Compared with conventional group, mild hypothermia group 7 d NIHSS and 24 h, 7 d ICP and ScvO2 improved significantly (P < 0.05). (3) The CVP, MAP, PT, and PLT showed no difference in two groups before and after-treatment . ( 4 ) Rate of good outcome in mild hypothermia group was significantly higher than conventional group in 90 days (P < 0.01); while the mortality rate showed no difference. Conclusions Mild hypothermia can obviously improve END in stroke with intra-arterial thrombolysise, bring better outcome among survival patients, though can not reduce mortality.%目的：探讨亚低温对大动脉闭塞性脑卒中动脉溶栓后早期神经功能恶化（END）的影响。方法：50例动脉溶栓术后END患者随机分为亚低温组和常规组，比较两组治疗前和治疗后24 h、7 d颅内压（ICP）、中心静脉压（CVP）、平均动脉压（MAP）、血K＋、凝血酶原时间（PT）、血小板计数（PLT）、中心静脉血氧饱和度（ScvO2）和NIHSS 评分，用MRS 评价90 d 预后和病死率。结果：（1）与治疗前比较，亚低温组7 d 时 NIHSS评分降低（P ＜0．01）；24 h、7 d 时 ICP 和 ScvO2改善（P ＜0．05）；24 h 时血 K＋降低（P ＜0．05），7 d 时血 K＋无显著差异。（2）与常规组比较，亚低温组7 d时NIHSS评分和24 h、7 d ICP和ScvO2均有改善（P＜0．05）。（3）两组治疗前后CVP、MAP、PT和PLT无显著差异。（4）亚低温组90 d转归良好率高于常规组（P＜0．01），病死率与常规组比较无显著差异。结论：亚低温可改善脑卒中动脉溶栓后END ，虽不能降低病死率，但能给生存患者带来更好的转归。