头部低温启始时间对大面积脑梗死预后的影响
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李新立 夏强 程正祥 张元伟 刘群才【摘要】 目的 观察头部低温启始时间对大面积脑梗死(LCI)患者预后的影响，探讨头部低温最佳启始时间窗。方法 92例患者中脑梗死后≤6 h头部低温治疗者为A组(31例)；脑梗死后7~10 h治疗者为B组(31例)；脑梗死后11~14 h治疗者为C组(30例)。以病死率、梗死灶体积、神经功能缺损程度评分(NDS)、生存者预后日常生活质量(ADL)等为观察指标。结果头部低温治疗后梗死灶体积A、B两组均较C组明显缩小(P均<0.01)。以C组病死率为高(26.67%比A组3.23%、B组6.45%，P均<0.05)；C组高热生存者病死率最高(75.00%比A组0、B组11.11%，P均<0.05)。生存者预后NDS与ADL A、B两组较C组也明显减少或降低，差异有显著性(P均<0.01)；C组高热生存者与A、B两组高热生存者预后NDS和ADL比较差异有显著性(P均<0.05)。结论以LCI发病10 h内进行头部低温治疗效果最佳，11 h后效果不显著。
【关键词】 治疗启始时间； 大面积脑梗死； 头部低温； 预后
Influence of beginning time of hypothermia treatment on prognosis of extensive cerebral infarction LI Xin-li, XIA Qiang, CHENG Zheng-xiang, ZHANG Yuan-wei, LIU Qun-cai。Department of Neurology, the 159th Hospital of PLA, Zhumadian 463008, Henan China
OBJECTIVE: To study the influence of begining time of cranial hypothermia treatment on the prognosis of extensive cerebral infarction(ECI) so as to extablish the optimum time for such treatment. METHODS: Ninety-two ECI patients were divided into three groups. In group A hypothermia treatment was begun within 6 hours after cerebral infarction in 31 patients. In another 31 cases in group B it was begun in 7-10 hours, and in 30 cases in group C it was begun in 11-14 hours after the attack. The mortality rate, the volume of cerebral infarction, neurological deficiency score(NDS) and quality of life in survivors were determined respectively in three groups. RESULTS: The volume of cerebral infarction in group A and B was obviously smaller than that of group C after hypothermia treatment (P<0.01). The mortality rate was higher in group C (26.67% in group C, 3.23% in group A and 6.45% in group B, both P<0.05) The mortality rate was highest in cases with high body temperature in group C(P<0.05). NDS was significantly lower in surviovors of groups A and B compared with group C (both P<0.05), groups A and B compared with group C (P<0.05). The NDS and qulity of life of the survivors with high body temperature (P<0.05 or P<0.01).CONCLUSION: Cranial hypothermia treatment should be begun with 10 hours after illness to obtain best effect. ......
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