Hypothermia treatment of 24 cases with severe head

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Hypothermia treatment of 24 cases with severe head injury

Key words, brain injury Abstract Objective 24 cases of severe head injury (GCS score 3 to 8 points) in the treatment of the treatment and prognosis. Methods From November 1994 ~ December 2004 admitted 24 cases of severe injury were analyzed retrospectively. Results Of 24 patients with severe head injury 15 cases were cured, 5 cases improved, 4 patients died. Conclusions Mild traumatic brain injury hypothermia treatment is one of the comprehensive treatment can reduce mortality, morbidity, improve the cure rate of mild hypothermia on traumatic brain injury have a positive effect, should be widely applied. Chinese papers League finishing. Key words brain injury hypothermia treatment is the treatment of mild hypothermia on severe head injury treatment the most effective way, in recent years, clinical application to achieve better results, but many problems still to be further exploration. Our hospital in November 1994 ~ December 2004 with mild hypothermia on severe head injury, 24 cases are analyzed as follows. 1 clinical data 1.1 General information the 24 patients with severe brain injury patients, 16 males and 8 females, aged 81 years maximum, minimum 4 years old, average 35 years old, injury to admission time 15min ~ 3h, an average of 1h; causes of injury: road accident in 14 cases, 9 cases of fall injury, hypertension, cerebrovascular accident in 1 case. 1.2 after diagnosis and clinical diagnosis of 17 cases of severe brain contusion, brain stem injury in 7 cases, 21 patients with intracranial hematoma; GCS score: 3 to 5 minutes in 19 cases, 6 to 8 points in 5 cases; Bilateral mydriasis in 11 cases, 13 cases of unilateral mydriasis. Clinical course: Getting started with hypothermia after injury 3h ~ 7 days, an average of 1.5 days, the longest 20 days, minimum 4 days. And the bone flap craniotomy decompression line hematoma in 17 cases, 19 cases of tracheotomy, 15 patients with central heating, cooling hypothermia treatment over the course of induced cardiac arrest in 2 cases, 3 cases of pulmonary infection. Monitoring: All patients in the mild hypothermia treatment room to give heart rate, blood pressure, respiration, ECG, blood oxygen saturation monitoring, some patients received central venous pressure and intracranial pressure monitoring. 1.3 method of using hypothermia therapy lytic cocktail (chlorpromazine 50mg, promethazine 50mg, meperidine 100mg) intramuscularly, 30min after the use of systemic ice blanket, ice caps cool, so after the 6 ~ 8h rectal temperature dropped to 32 ℃ ~ 34 ℃, and control at this temperature level, through the peak of brain edema gradually rewarming. 2 results 24 patients, 5 died, 4 cases improved, both limb movement disorder and mental disorders, 15 patients recovered, the mortality rate of 21%. 3 discussions severe head injury (GCS score 3 to 8 points) mortality and morbidity were much higher than the light. Domestic bulk reported cases of mortality between 17.6% ~ 41.7% [1,2]. Although medical intervention can not change the existing primary injury,[link widoczny dla zalogowanych], but in addition to . According to the treatment of mild hypothermia for cerebral protection, and we implemented the hypothermia patients and achieved good results. 3.1 mechanism by hypothermia hypothermia can significantly reduce lactic acid accumulation to protect the blood-brain barrier, cerebral edema, relieve intracranial pressure, inhibiting the release of harmful substances, reduce protein damage brain cells, reduce the brain tissue damage to brain cell structure and function to promote the recovery of [3 ~ 5]. Based on experimental studies, decreased body temperature every 1 ℃, cerebral blood flow decreased by 6% to 7%, 5.5% lower intracranial pressure, brain tissue metabolism reduced accordingly, at 30 ℃, the brain metabolism of 50% of normal, cerebral metabolic rate decline, can improve the brain tolerance to hypoxia, studies confirm: 30 ℃, the cerebral protective effect of 2, [6].