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目的:研究亚低温对重型颅脑损伤患者血清早期凝血、纤溶及炎症因子的影响。方法:66例重型颅脑损伤患者随机分为亚低温治疗组和对照组,对照组除了不进行亚低温治疗外其他治疗方法与亚低温治疗组相同,分别于治疗前和治疗第1、3、7天采用酶联免疫吸附试验(ELISA)测定纤溶酶原激活剂抑制物-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)和白细胞介素-8(IL-8)的含量;采用免疫浊度法测定抗凝血酶Ⅲ(AT-Ⅲ)的含量。伤后1年对两组患者预后按GCS进行评估。结果:亚低温组与对照组患者伤后入院第1天及第3天各指标比较,两组无统计学差异;住院后第7天检测,对照组PAI-I、t-PA、IL-8值较亚低温组高,差别有统计学意义(P<0.05);对照组AT-Ⅲ值显著低于亚低温组(P<0.05);GOS预后评分明显优于对照组(P<0.05)。亚低温治疗组患者预后良好(轻残+中残)率明显高于常温治疗组(P<0.05),植物生存率及死亡率低于常温治疗组(P<0.05)。结论:亚低温对重型颅脑损伤患者早期凝血纤溶及炎症指标具有显著影响。以早期凝血纤溶及炎症指标作为量化指标,在一定程度上能反映亚低温的疗效并预测预后。
Objective: To study the effect of mild hypothermia on serum coagulation, fibrinolysis and inflammatory factors in patients with severe craniocerebral injury. Methods: Sixty-six patients with severe traumatic brain injury were randomly divided into mild hypothermia treatment group and control group. The control group was the same as the mild hypothermia treatment group except mild hypothermia treatment, The levels of plasminogen activator inhibitor-1 (PAI-1), tissue-type plasminogen activator (t-PA) and interleukin-8 (IL- 8). The content of antithrombin Ⅲ (AT-Ⅲ) was determined by immunoturbidimetry. One year after injury, the prognosis of both groups was evaluated by GCS. Results: Compared with the control group, PAI-I, t-PA and IL-8 levels in the control group were significantly lower than those in the control group (P <0.05). The AT-Ⅲ in the control group was significantly lower than that in the mild hypothermia group (P <0.05). The GOS prognosis score was significantly better than that in the control group (P <0.05). The patients with mild hypothermia had a good prognosis (light residue + mid-residue), which was significantly higher than that of the normal temperature treatment group (P <0.05). The plant survival rate and mortality rate were lower than those of the normal temperature treatment group (P <0.05). Conclusion: Mild hypothermia has a significant effect on the indexes of early coagulation, fibrinolysis and inflammation in patients with severe craniocerebral injury. To early coagulation fibrinolysis and inflammation indicators as a quantitative indicator, to a certain extent, can reflect the efficacy of mild hypothermia and predict prognosis.