The clinical application of moderate hypothermia / 中华急诊医学杂志

ABSTRACT

Objective To study the moderate hypothermia with iced saline given intravenously with ice cap and ice sheet used in patients with severe stroke or craniocerebral trauma in order to clarify its clinical therapeutic effect and recovery of neurologic function for providing reliable clinical data.Methods A total of 84 patients suffered severe stroke (cerebral hemorrhage or cerebral infarction) or traumatic brain injury with GCS (Glascow Coma Scale) ＜8 admitted within 24 hours after onset were enrolled for study.The exclusion criteria were functional decompemsation of heart,liver,kidney and lung as cardiovascular complications of hypertension,hematological and other diseases,and craniocerebral trauma with multiple injuries of thorax,abdomen and extremities.Patients were divided into observation group and control group (n =42 in each group).The patients of two groups were managed to maintain respiratory tract patent,prevention of infection,dehydration,reduction of intracranial pressure and treated with Cytidine Diphosphate Choline,piracetam,ganglioside sodium and other conventional therapy.In control group,patients treated with ice cap and ice sheet,whereas in observation group,patients were treated with iced saline injected intravenously in addition to ice cap and sheet.At admission,the GCS score of patients was assessed and 6 months later,GCS score and Glascow Outcome Scale,(GOS) score of patients were determined,and 12 months after the treatment,quality of life score were evaluated by KPS.Results The time from onset of stroke or from trauma accident occurred to initiation of hypothermia treatment and time from initiation of hypothermia therapy to the target temperature reached in observation group were (8 ±4) hours and (3± 1 )hours respectively,and in control group,they were ( 16± 5) hours and (6 ± 2) hours,and there were significant differences between two groups ( P ＜ 0.05 ).The mean GCS score of patients at 6 months in the observation group and in the control group were (7.01 ± 1.12) and (4.02 ± 1.11 ) respectively (P ＜0.05 ) ; whereas the GOS score at 6 mouths of patients was categorized into good outcome,disabled outcome and poor outcome,and the good outcome in the observation group was significantly better than that in the control group (P ＜ 0.05 ),and no statistically significant difference in disabled outcome was found between two groups (P ＞ 0.05),and the poor outcome of GOS score was significantly lower in observation group than that in control group ( P ＜0.05 ).Twelve months after the treatment,the long-term quality of patients'life assessed by KPS score in observation group was significantly better than that in control group ( P ＜ 0.05).Conclusions The moderate hypothermia therapy by using iced saline administered intravenously combined with ice cap and ice sheet for severe stroke and head trauma patients conferred better therapeutic effects than the treatment with ice cap and ice sheet.