Effect of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each)ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.