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目的研究全身亚低温不同起始时间对急性脑梗死近期与远期预后的影响,以进一步探讨亚低温治疗最佳时间窗。方法对急性大面积脑梗死患者117例,随机分为亚低温治疗组6~12h时(A1)22例及12~24h(A2)32例;对照组6~12h(B1)30例及12~24h(B2)33例。对照组予常规抗血小板、降脂稳定斑块、改善循环、脑保护及对症治疗,亚低温治疗组在常规治疗的基础上采用全身亚低温治疗,配合冬眠合剂。使肛温控制在33~35℃。降温持续时间5~7d。评定治疗前、治疗后第7、14天、1、3、6个月各时间点NIHSS评分、MRS评分。并记录死亡、再发脑梗死等终点事件。结果 1起始时间6~12h与12~24h亚低温治疗组的近期疗效与远期疗效均优于各自对照组。26~12h亚低温组近期与远期疗效均优于12~24h亚低温组。3肺部感染是亚低温治疗较常见并发症,但可降低急性脑梗死患者应激性溃疡、脑心综合征的并发症。结论 24h内长程亚低温治疗急性脑梗死可改善神经功能,降低致残率,且越早效果越好。
Objective To study the effect of different onset time of systemic mild hypothermia on the short-term and long-term prognosis of acute cerebral infarction in order to further explore the optimal time window for mild hypothermia. Methods A total of 117 patients with acute large area cerebral infarction were randomly divided into mild hypothermia treatment group (A1 ~ A1), 32 cases (12 ~ 24h) and A2 (A2 ~ 24h (B2) 33 cases. The control group was given conventional antiplatelet, stable lipid-lowering plaque, and improved circulation, brain protection and symptomatic treatment. The mild hypothermia treatment group was treated with systemic hypothermia on the basis of routine treatment, with hibernation mixture. Rectal temperature control at 33 ~ 35 ℃. Cooling duration of 5 ~ 7d. The NIHSS score and MRS score were evaluated before treatment, 7th, 14th, and 1th, 3rd and 6th month after treatment. And record death, recurrent cerebral infarction and other end events. Results1 The short-term and long-term effects of the mild hypothermia therapy group from 6 to 12 hours and from 12 to 24 hours were better than the control group. The short-term and long-term effects of 26 ~ 12h hypothermia group were better than those of 12 ~ 24h hypothermia group. 3 pulmonary infection is a more common complication of mild hypothermia, but can reduce stress ulcer in patients with acute cerebral infarction, brain syndrome complications. Conclusion Treatment of acute cerebral infarction with long-range hypothermia within 24 hours can improve neurological function, reduce the morbidity, and the earlier the effect is, the better.