| Objectives:To study the influence of endovascular cooling hypothermia on the ICP,blood glucose and lactate of patients with sTBI.To explore the clinical effect and its safety of endovascular cooling hypothermia.To measure the nursing time devoted to managing patient temperature and the cost of inpatients.Methods:All 107 patients with sTBI who met the inclusion criterion from the brain rescue center of Tianjin Huanhu Hospital since May 2009 to July 2010 were randomly divided into endovascular hypothermia group (group A,34 cases), conventional hypothermia group (group B,36 cases) and conventional treatment group (group C,37 cases). All the patients received the routine neurosurgical treatment and the routine care. Patients in group A were also received endovascular cooling hypothermia, and patients in groupB were received conventional hypothermia. The time to rearch target temperature and temperature values that were out of the target range were monitored. And in order to evaluate the grade of shiver, we made use of the Bedside Shivering Assessment Scale (BSAS). In addition, we also regularly monitored patients with ICP values, vital signs, blood gas analysis (including blood glucose and lactate), blood electrolyte changes, and the nursing time devoted to managing patient temperature and the cost of inpatients. In three months after injury, we evaluated the prognosis of all patients according to GOS.Results:1. Compared with the conventional hypothermia group, time to reach the target temperature in group A was significantly shorter than in group B(P<0.05). In group B significantly more temperature values were out of the target range than in group A(P<0.05). In addition, the incidence of tracheostomy and mechanical ventilation in group A is also lower than group B (P<0.05).2.The evaluated ICP were significantly reduced under endovascular hypothermia(P<0.05).After rewarming,the mean ICP was still on normal level.3. In comparison with conventional treatment group,the hyperglycemia and raised blood lactate significantly decreased in the two mild hypothermia groups (group A and group B) (P<0.05), but between the two methods of mild hypothermia there was no significant difference (P> 0.05).4. There was no serious complications such as hypotension, arrhythmia, electrolyte imbalance, blood clotting disorder in endovascular hypothermia group, and there was no statistically significant difference in the lung infection, deep vein thrombosis and cerebral hernia between the groups(P>0.05).5. The prognosis of the patients in group A and group B was better than that of the patients in group C(P<0.05).But between the two hypothermia groups,there was no significant difference(P> 0.05).6. The nursing time devoted to managing patient temperature was significantly different between group A and group B(p<0.05). The ICU stay and hospital stay in the endovascular hypothermia group were shorter than other two groups(P<0.05).But there was no significant difference with patient hospitalization costs among the three groups (P>0.05).7.Multiple stepwise regression analysis in the endovascular hypothermia group revealed that admission GCS, therapeutic time to treat patients and time to reach the target temperature were the independent factors to affect the patient prognosis when GOS as the dependent variable.Conclusions:Endovascular hypothermia is fast to induce hypothermia, sustaining temperature is stable.And it can effectively reduce the value of ICP, relieve cerebral edema which protect patients from brain hernia. Endovascular hypothermia is also reducing the level of blood glucose and lactate; It plays the role of cerebral protection. There was no serious complication in endovascular hypothermia, so it is safe and reliable.The patient prognosis in endovascular hypothermia group is better than conventional treatment group, but it is the same to conventional hypothermia group. The nursing time devoted to managing patient temperature is reduced, and the ICU stay and hospital stay in the endovascular hypothermia group were shorter than other two groups. But it can not reduce the total cost of hospitalization. Prognostic factors analysis revealed that the higher the GCS score, the better the prognosis.And the shorter therapeutic time to treat patients and time to reach the target temperature, the better the prognosis...
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