恒温毯保温对重型脑外伤患者血管内低温治疗效果的影响

doi:10.3969/j.issn.1006-9771.2020.07.024

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 863-868.doi: 10.3969/j.issn.1006-9771.2020.07.024

• 康复护理 • 上一篇

恒温毯保温对重型脑外伤患者血管内低温治疗效果的影响

廖利萍^1a,陈鹏^1a,王科^1a,吴晓苏^1a,陈英^1a,张晞^1b(),赵洁²,王军²,曲鑫²

1.重庆市急救医疗中心,a. 神经外科;b. 老年科,重庆市 400014
2.首都医科大学宣武医院神经外科,北京市 100053

收稿日期:2019-12-30 修回日期:2020-03-23 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 张晞 E-mail:501872175@qq.com
作者简介:廖利萍(1988-),女,汉族,重庆市人,主管护师,主要从事神经护理。
基金资助:
重庆市教育委员会科学技术研究项目(KJQN201800122)

Effect of Self-warming Blankets on Intravascular Hypothermia for Severe Traumatic Brain Injury

LIAO Li-ping^1a,CHEN Peng^1a,WANG Ke^1a,WU Xiao-su^1a,CHEN Ying^1a,ZHANG Xi^1b(),ZHAO Jie²,WANG Jun²,QU Xin²

1. a. Neurosurgery Department, b. Geriatrics Department, Chongqing Emergency Medical Center, Chongqing 400014, China
2. Neurosurgery Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Received:2019-12-30 Revised:2020-03-23 Published:2020-07-25 Online:2020-07-24
Contact: ZHANG Xi E-mail:501872175@qq.com
Supported by:
Chongqing Municipal Education Comission Science and Technology Research Program(KJQN201800122)

摘要/Abstract

摘要：

目的观察恒温毯保温在重型脑外伤(sTBI)患者血管内低温治疗中的效果。方法回顾性分析2013年1月至2018年12月行血管内低温治疗的sTBI患者112例,根据是否采用36.5 ℃恒温保温毯进行体表保温,将患者分为对照组(n = 58)和观察组(n = 54)。采用床边寒战评估量表(BSAS)评估患者寒战发生率和级别,记录两组低温治疗中抗寒战药物用量、凝血功能、颅内压,以及治疗后1个月、6个月、12个月后扩展版格拉斯哥预后量表(GOSE)评分和病死率。结果观察组寒战发生率和寒战严重程度均明显低于对照组(χ² = 16.212, P < 0.01);观察组抗寒战药物用量少于对照组 ( t > 1.269, P < 0.05)。观察组低温治疗6 h时,高凝状态开始改善,12 h时趋于稳定;对照组低温治疗12 h时,高凝状态开始改善,24 h时趋于稳定。观察组低温治疗6 h后,颅内压低于对照组。观察组治疗后1个月、6个月、12个月后,GOSE评分和病死率均低于对照组( t > 1.168, P < 0.05)。结论采用恒温毯保温可有效降低sTBI患者血管内低温治疗时寒战发生率和严重程度,改善高凝血症,降低颅内压,改善预后。

关键词: 重型脑外伤, 恒温保温毯, 血管内低温治疗, 寒战, 高凝血症, 颅内压

Abstract:

Objective To investigate the effect of constant temperature blankets on intravascular hypothermia for severe traumatic brain injury (sTBI). Methods A total of 112 inpatients with sTBI from January, 2013 to December, 2018 were reviewed. They were divided into control group (n = 58) and observation group (n = 54) according to whether a self-warming blanket was used. They were assessed with Bedside Shivering Assessment Scale (BSAS). Their dosages of anti-shivering medicine, coagulation and intracranial pressure were recorded. The scores of Glasgow Outcome Scale Extended (GOSE) and the mortality one, six and twelve months after discharge were observed. Results The incidence and severity were less in the observation group than in the control group (χ² = 16.212, P < 0.01). The dosage of anti-shivering medicine was less in the observation group than in the control group ( t > 1.269, P < 0.05). The hypercoagulation relieved significantly six hours after hypothermia in the observation group, and it was stable twelve hours after hypothermia. For the control group, the hypercoagulation relieved significantly twelve hours after hypothermia, and it was stable 24 hours after hypothermia. The intracranial pressure decreased more in the observation group than in the control group. The GOSE score and the mortality were less in the observation group than in the control group ( t > 1.168, P < 0.05) one, six and twelve months after discharge. Conclusion Application of self-warming blankets in intravascular hypothermia for sTBI may relieve shivering, hypercoagulation and intracranial pressure, to improve the outcome of patients.

Key words: severe traumatic brain injury, self-warming blanket, intravascular hypothermia, shivering, hypercoagulation, intracranial pressure

中图分类号:

R651.1

廖利萍,陈鹏,王科,吴晓苏,陈英,张晞,赵洁,王军,曲鑫. 恒温毯保温对重型脑外伤患者血管内低温治疗效果的影响[J]. 《中国康复理论与实践》, 2020, 26(7): 863-868.

LIAO Li-ping,CHEN Peng,WANG Ke,WU Xiao-su,CHEN Ying,ZHANG Xi,ZHAO Jie,WANG Jun,QU Xin. Effect of Self-warming Blankets on Intravascular Hypothermia for Severe Traumatic Brain Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 863-868.

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组别	n	性别(n)		年龄(岁)	病程(d)	损伤类型(n)
组别	n	男	女	年龄(岁)	病程(d)	硬膜下血肿	硬膜外血肿	颅内血肿	脑挫裂伤	弥漫性轴索损伤	蛛网膜下腔出血
对照组	58	32	26	37.16±12.09	217±11.65	14	12	11	9	7	5
观察组	54	28	26	36.75±11.79	209±10.16	11	11	9	8	8	7
χ²/t值		0.632		0.115	0.358	0.996
P值		0.715		0.366	0.524	0.816

组别	n	丁螺环酮	哌替啶
对照组	58	79.82±7.16	471.38±49.63
观察组	54	50.11±6.23	367.95±50.63
t值		1.269	1.766
P值		0.037	0.022

组别	n	1个月	6个月	12个月
对照组	58	4.12±0.16	4.65±0.29	4.71±0.35
观察组	54	4.31±0.21	5.03±0.17	5.66±0.51
t值		1.081	1.273	1.756
P值		0.039	0.032	0.037

恒温毯保温对重型脑外伤患者血管内低温治疗效果的影响

Effect of Self-warming Blankets on Intravascular Hypothermia for Severe Traumatic Brain Injury

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组别	n	0级	1级	2级	3级
对照组	58	28	18	6	6
观察组	54	46	4	2	2