论文部分内容阅读
目的研究亚低温治疗重型颅脑损伤对T细胞亚群及预后的影响。方法选择某院重型颅脑损伤患者87例,分治疗组49例和对照组38例;两组均经常规手术治疗,治疗组用亚低温和冬眠疗法,持续至术后4～7 d,当颅内压降至正常后,12 h内将体温恢复至正常;对照组维持正常体温;检测患者亚低温治疗前与治疗后7 d、14 d患侧颈动脉最低血流速度(Vmin)和颈动脉最低血流量(Qmin);检测治疗前和治疗后14 d T细胞亚群的变化;观察两组治疗后14 d神智清醒率;并进行统计分析。结果治疗组与对照组治疗前、治疗后7 d、14 d Vmin(cm/s)分别为7.51±0.59与7.61±0.74、10.93±0.82与8.32±0.69、11.97±0.84与8.97±0.43,Qmin(ml/s)分别为2.47±0.31与2.42±0.29、4.49±0.34与3.45±0.31、4.97±0.31与3.852±0.41,脑水肿体积(cm3)分别为92.51±11.62与93.88±10.87、78.21±9.54与86.35±8.87、72.42±7.56与84.54±9.33,两组治疗后7 d、14 d与治疗前比较,两组治疗后7 d、14 d间比较差异均有统计学意义(P﹤0.05);两组治疗后神智清醒发生率分别为21例(占43.85%)和9例(占24.59%),两组间比较差异有统计学意义(P﹤0.05);治疗组与对照组治疗前和治疗后14 d CD3+、CD4+、CD8+、CD4+/CD8+分别为51.53±7.56和68.39±9.68与49.74±8.27和52.27±9.32、34.76±5.65和51.23±8.46与35.26±6.13和38.67±7.53、18.61±5.26和13.85±4.37与17.94±6.13和15.91±6.08、1.51±0.19和4.17±1.27与1.47±0.21和2.52±1.34,治疗组治疗后14 d与治疗前比较,及治疗后14 d与对照组比较差异均有统计学意义(P﹤0.05)。结论亚低温治疗重型颅脑损伤疗效显著,并可提高患者CD3+和CD4+值升高,CD8+值降低,提高患者的免疫功能和创伤的耐受能力,促进脑组织的康复具有重要的作用。
Objective To study the effects of mild hypothermia on T cell subsets and prognosis in patients with severe craniocerebral injury. Methods 87 cases of severe craniocerebral injury in a hospital were divided into treatment group (n = 49) and control group (n = 38). Both groups were treated by conventional surgery. The patients in treatment group were treated with mild hypothermia and hibernation therapy for 4-7 days after operation. The intracranial temperature returned to normal within 12 hours after the intracranial pressure was reduced to normal. The control group maintained normal body temperature. The minimum carotid artery blood flow velocity (Vmin) and neck before and 7 and 14 days after treatment The lowest blood flow (Qmin) of the artery was measured. The changes of T cell subsets before and after 14 days of treatment were observed. The soberness rate of the two groups was observed 14 days after treatment. Statistical analysis was performed. Results Before treatment, Vmin (cm / s) at 7 and 14 days after treatment were 7.51 ± 0.59 and 7.61 ± 0.74, 10.93 ± 0.82 and 8.32 ± 0.69, 11.97 ± 0.84 and 8.97 ± 0.43, respectively, ml / s) were 2.47 ± 0.31 and 2.42 ± 0.29, 4.49 ± 0.34 and 3.45 ± 0.31, 4.97 ± 0.31 and 3.852 ± 0.41, and the volume of brain edema (cm3) were 92.51 ± 11.62 and 93.88 ± 10.87,78.21 ± 9.54 and 86.35 ± 8.87,72.42 ± 7.56 and 84.54 ± 9.33 respectively. There was significant difference between the two groups on the 7th and the 14th days after treatment (P <0.05) There were 21 cases (43.85%) and 9 cases (24.59%) in conscious group after treatment, the difference was statistically significant between the two groups (P <0.05); before treatment and after treatment 51.53 ± 7.56 and 68.39 ± 9.68 and 49.74 ± 8.27 and 52.27 ± 9.32, 34.76 ± 5.65 and 51.23 ± 8.46 and 35.26 ± 6.13 and 38.67 ± 7.53, 18.61 ± 5.26 and 13.85 at 14 d, respectively ± 4.37 and 17.94 ± 6.13 and 15.91 ± 6.08, 1.51 ± 0.19 and 4.17 ± 1.27 and 1.47 ± 0.21 and 2.52 ± 1.34, respectively, compared with those before treatment and 14 days after treatment in the treatment group Statistically significant (P <0.05). Conclusion Mild hypothermia is effective in treating severe craniocerebral injury. It can increase CD3 + and CD4 + levels, decrease CD8 +, improve immune function and trauma tolerance, and promote the recovery of brain tissue.