颅脑损伤亚低温治疗【亚低温辅助治疗对急性重型颅脑损伤患者外周血神经元特异性烯醇化酶、一氧化氮和C反应蛋白水平的影响】

　　[摘要] 目的 探讨亚低温治疗对急性重型颅脑损伤患者外周血神经元特异性烯醇化酶（NSE）、一氧化氮（NO）和C反应蛋白（CRP）水平的影响。 方法 将90例急性重型颅脑损伤患者随机分为对照组（n = 45）和观察组（n = 45）。两组均给予常规治疗，观察组联合亚低温辅助治疗。观察治疗前后两组患者的外周血神经元特异性烯醇化酶（neuron specific enolase，NSE）、一氧化氮（nitric oxide，NO）和C反应蛋白（C-reactive protein ，CRP）水平变化。结果 观察组预后良好率和病死率分别为46.67%（21/45）和11.11%（5/45），明显优于对照组的28.89%（13/45）和24.44%（11/45）（P < 0.05）。治疗后第3、5天和复温后（第7天）观察组NSE、NO和CRP水平均明显低于对照组（P < 0.05）。 结论 亚低温辅助治疗急性重型颅脑损伤的疗效显著，可有效降低NSE、NO和CRP的水平，减轻脑组织的继发性损伤，降低病死率，改善预后。
　　[关键词] 亚低温；急性重型颅脑损伤；神经元特异性烯醇化酶；一氧化氮；C反应蛋白
　　[中图分类号] R651.15 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0026-03
　　The influence of mild hypothermia auxiliary treatment on blood neurons specific enolase, nitric oxide and C-reactive protein in patient with acute severe brain injury
　　LIU Enhe1 PENG Yongguang1 HONG Jian2
　　1.The Third Department of Surgery, People"s Hospital of Qianxi County in Tangshan City, Hebei Province, Qianxi 064300, China; 2.Department of Surgery, Tianjin Huanhu Hospital, Tianjin 300060, China
　　[Abstract] Objective To study the influence of mild hypothermia auxiliary treatment on blood neurons specific enolase (NSE), nitric oxide (NO) and C-reactive protein (CRP) in patient with acute severe brain injury. Methods 90 cases of patients with acute severe brain injury were randomly divided into the control group (n = 45) and the observation group (n = 45). The two groups were all given conventional therapy, the observation group were combined with mild hypothermia auxiliary treatment. The change of blood NSE, NO and CRP before and after treatment in the two group were observed. Results The recovery rate and mortality in the observation group were 46.67% (21/45) and 11.11% (5/45) respectively, which were much better than 28.89% (13/45) and 24.44% (11/45) in the control group (P < 0.05). NSE, NO and CRP levels of the observation group were significantly lower than those of the control group at 3, 5 days and rewarming after treatment (P < 0.05). Conclusion The effect of mild hypothermia auxiliary treatment on patient with acute severe brain injury is distinct, which can effectively reduce NSE, NO and CRP levels, reduce the secondary injury of brain and mortality, improve the prognosis.
　　[Key words] Mild hypothermia; Acute severe brain injury; Neurons specific enolase; Nitric oxide; C-reactive protein
　　急性重型颅脑损伤发病急剧、病情多变、神经功能损伤程度较重、并发症多、短期病死率高、预后较差，其中，多器官功能障碍综合征（multiple organ dysfunction syndmm，MODS）和全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）是导致的继发性损伤的重要危险因素之一，而且其严重程度与病死率呈正相关[1]。研究结果证实，亚低温辅助治疗重型颅脑损伤可有效降低脑组织耗氧量，改善微循环，减少毒性物质释放对脑组织的继发性损害[2-3]。目前动物实验证实，亚低温可降低颅脑损伤动物模型的外周血神经元特异性烯醇化酶（neuron specific enolase，NSE）、一氧化氮（nitric oxide，NO）和C反应蛋白（C-reactive protein ，CRP）水平，但临床报道较少。本研究对我院收治的急性重型颅脑损伤患者采用亚低温辅助治疗，并监测治疗前后NSE、NO和CRP水平的变化，旨在探讨亚低温辅助治疗对颅脑损伤患者血NSE、NO和CRP水平及预后的影响。