The Research Of The Optimal Way Of Cooling Therapy In Patients With Severe Traumatic Brain Injury After Operation

Objective Severe traumatic brain injury(STBI)is a kind of severe disease which often occurs in Intensive Care Units(ICUs),at the same time,it also has a high rate of morbidity and mortality.STBI can damage the blood brain barrier,brain tissue and endothelial cells,it also can activate endogenous and exogenous coagulation pathway of the patients.Then it can cause cerebral hypoxia,acidosis and shock with other complications.Therefore,after the surgery of the STBI often come up with the secondary brain edema and can produce a large number of oxygen free radicals and many other harmful substances,which affect the brain function,may associate with the complications and prognosis of the patients.Many researches found that mild hypothermia can be beneficial to the TBI,including prevent the high coagulation condition after the surgery of the TBI and make the oxygen free radicals producing slow down and so on.There are many ways to cool the body temperature to the mild hypothermia condition,such as ice cap local cooling,ice blanket and ice cap with ice blanket etc,is the international well recognized.But which method is the best to treat the patient have on researches.Our study will compare the amount of bleeding after the surgery,blood coagulation index,SOD with MDA,the complications and prognosis,and find the optimal way to mild hypothermia to TBI patients.Methods We designed a prospective randomized study of single center,the selection of cases in surgical intensive care unit from 2012 August to 2014 October in Chifeng institute affiliated Hospital(intensive care unit,ICU)of 84 patients with STBI,who all were treated wiht operation.The inclusion standard is the 2012 National Conference in cerebrovascular diseases.The patients' Glasgow core were less than or equal to eight;the patients all Limb paralysis of its muscle strength under four;all age are betwee 40-80 years old;no serious diabetes and cardiac arrhythmia;and exclusion patients who has severe liver and kidney failure,heart failure and multiple organ failure(MOF).The patients were randomly assigned to three treatment groups,group of ice cap local cooling(IC group),group of ice blanket(IB group)and group of ice blanket combined with intravenous infusion of cold physiologic saline(IB+NS group)etc.All patients in three groups were given conventional therapy,such as dehydration which reducing intracranial pressure;some drug can nutrition the brain nerve;promoting the comprehensive treatment of brain cell metabolism.We got the general characteristics of all patients,coagulation index(PT,APTT,TT,D-dimer),the SOD and MDA changes,complications and Glasgow outcome score(GCS)after 3 months.We diveded all patients three subgroups,the mild temperature(T<35 C),the normal temperature(T=35-37 C),and the fever group(T>37 C),and then analyse the prognosis of subgroups Glasgow outcome score(GCS)after 3 months and intracranial pressure.Results The characterics of all the patiens has no obvious differentence after the surgery of TBI.The method of ice caping can decreased naspharyngeal decreased,but it's rather difficult to reach mild hypothermia temperature.The body temperatue can decreased to less 35 C at twelve or thirteen hours with ice blanket,while the same coure can be finished at three or four hours with the method of ice blanket combind with intravenous infusion of cold physiologic saline,and the rate of the two groups achiveing mild temperature are seperately 46%,79%.The patients coagulation index: PT,APTT,TT were higher than the normal range,can recover to normal range rapidly,has no statistical significance(P >0.05).Mild hypothermia after operation in three groups(before treatment)and there is no significant difference of the content of serum SOD and MDA(P >0.05),after treatment,three groups of MDA content were decreased,SOD content increased,there was significant difference between the changes of IB group and IB+NS group than in IC group(P < 0.05),the changes of IB group and IB+NS group the difference is not obvious,no statistical significance(P >0.05).IB group and IB+NS group than in IC group delayed hematoma,stress ulcer,hyperfibrinolysis,brain heart syndrome and pulmonary infection rate decreased significantly(P < 0.05),while the three group the incidence of cerebral infarction was 0,IB group and IB+NS group,the incidence rate of complications is not very different,no obvious difference(P >0.05).Group IB and IB+NS for more security.There is no statistical significance between the three groups in mortality(P >0.05).The prognosis of IB group and IB+NS group are residual and good in the main,compared the poor prognosis of IC group,decreased significantly(P < 0.05);there is no significant difference in IB group and IB+NS group of poor prognosis(P >0.05).The subgroups of the prognosis of the mild hypothermia group and the normal group are mild residual and good in the main,there is no signifcant differene between the two groups,while the mortality decreased significantly(P < 0.05),and had better prognosis obviously(P < 0.05),compared with the fever group,Conclusion1.The cooling ways with ice blanket and ice blanket combined with intravenous infusion of cold physiologic saline can decreaced the body temperature more quicly,compared with the way of ice cap which used for decreased body temperature.2.As the method of whole body cooling,ice blanket combined with intravenous infusion of cold physiologic saline can acheive targeted temperature more easily,than the method of ice blanket,improve the prognosis of the patients.3.The effect of the mild hypothermia group and the normal temperature group is similar to the severe traumatic brain injury patients,the body temperature higher than normal may have worse results.