RESUMO
BACKGROUND: It is indicated in latest research that in cerebral protective measures of cerebral vasospasm induced by subarachnoid hemorrhage due to various factors in acute stage, mild hypothermia has been drawn the attention specially and it has been recommended in clinical practice. But such therapy is generally limited in experimental research and aneurysm hemorrhage, the clinical research on subhypothermia probably provides important influence on cerebral vasospasm in severe craniocerebral injury.OBJECTIVE: Based on cerebral vascular hemodynamical indexes (CVDI),the cerebral protection of subhypothermia was observed on cerebral vasospasm in severe craniocerebral injury.DESIGN: Randomized controlled experiment.SETTING: Department of Neurological Surgery of No.16 Hospital of Chinese PLA and General Military Institute of Neurological Medical Science in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA.PARTICIPANTS: Totally 36 cases of severe craniocerebral injury were selected in General Military Institute of Neurological Medical Science in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA from July 1997 to August 1999, which were randomized into the control and treatment group, 18 cases in each one. At same period, 24 cases with normal CVDI were screened and taken as normal group. All of receptors participated in the experiment in volunteer.METHODS: In both the control and treatment group, the treatment was applied with anti-inflammation, stopping bleeding, fluid limitation, dehydration, supporting, hyperbaric oxygen, etc. In the control, the normal body temperature was maintained and in treatment group, anus temperature was dropped to about 33 ℃ in 4 hours to 8 hours, which was maintained for 3-test was given on the day of injury (0), on the 1st, 3rd, 7th, 14th and 21st days assay was done on the day of injury (0), on the 1st, 3rd, 7th, 14th and 21st days successively, in which, minimum blood velocity (Vmin) and minimum blood flow (Qmin) reflect blood supply of distal cerebral vessel and blood flow.Cerebral vessel resistance (CVR) reflects smooth degree of cerebral microcirculation. Dynamical resistance (DR) reflects auto-regulation of cerebral vessel. Criteria of evaluation: Recovery state of consciousness was justified according to Glasgow Coma Scale (GCS) in 1 week after injury. The outcomes were evaluated according to Glasgow outcome scale (GOS) in 3 months (5 score: good, 4 score: moderate handicapped, 3 score: severely handicapped, 2 score: vegetative state and 1 score: death). The case over 4 score indicated good outcome.ery of consciousness and outcomes in 1 week after injury in the control and treatment group.RESULTS: Totally 36 cases of severe craniocerebral injury entered result phases after injury in the control, named hypoperfusion phase (0 day), hyperperfusion phase (1-3 days), cerebral vasospasm phase (4-14 days) and improving phase (＞15 days). In treatment group, 3 phases were manifested,named hypoperfusion phase (0 day), improving phase (1-3 days) and recovery phase (＞ 4 days), without hyperperfusion phase. Eight cases and 2 cases of cerebral vasospasmodic changes in CVDI presented in the control in focus: The maximum volume (140.9±22.95) cm3 was on the 14th day after injury in the control and that (95.83-±14.97) cm3 was on the 3rd day in treatment group. On the 14th day after injury, the volume in treatment group in 1 week after injury: It was 22.2% (4/18) in the control and 55.6%(10/18) (P ＜ 0.05) in treatment group. Improving outcome rate: It was 38.9% (7/18) and 66.7% (12/18) in treatment group.CONCLUSION: Subhypothermia reduces incidence of cerebral vasospasm by stabilizing cerebral circulation after severe craniocerebral injury, especially by inhibiting acute hyperperfusion after the injury so that the volume of cerebral edema in focus is lessened remarkably and the prognosis is improved.