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OBJECTIVE: This study aimed to observe the effect of local mild hypothermia on regional cerebral blood flow (rCBF) after acute intracerebral hemorrhage (ICH) and to evaluate its relation to clinical outcome in patients with ICH. METHODS: 36 CT proven ICH patients with Glasgow coma scale (GCS) score of 5 or more were randomly assigned to 2 group: local mild hypothermia with conventional mannitol (Group A) or conventional mannitol (Group B). SPECT study was performed at day 7 after therapy. The SPECT images were semi-quantitatively analyzed, and the radioactivity ratios of lesion to normal tissue (L/NT) were calculated. National Institutes of Health Stroke Scale (NIHSS) were used in evaluation at days 14 and 21 after therapy. RESULTS: There were significant differences in NIHSS score at days 14 and 21, and the L/NT ratios between the groups A and B (P < 0.05). Based on GCS, more patients in the group A showed favorable outcomes than patients in the group B (P < 0.05). Furthermore, the L/NT ratios significantly increased in patients with favorable outcomes compared to poor outcomes. Changes in NIHSS score at days 14 and 21 were closely negatively correlated with the L/NT ratios in the groups A and B (r= -0.58, -0.61, and -0.52, -0.75, respectively, P < 0.05). CONCLUSION: Local mild hypothermia could significantly increase rCBF and improve clinical outcome in ICH patients as evaluated by ^{99m}Tc-ECD SPECT study.

Asunto(s)

Hemorragia Cerebral/fisiopatología , Hemorragia Cerebral/terapia , Circulación Cerebrovascular , Cisteína/análogos & derivados , Hipertermia Inducida/métodos , Compuestos de Organotecnecio , Tomografía Computarizada de Emisión de Fotón Único/métodos , Enfermedad Aguda , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Hemorragia Cerebral/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Radiofármacos , Flujo Sanguíneo Regional , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento

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Objective To study the effect of local mild hypothermia on serum brain natriuretic peptide (BNP) in patients with acute intracerebral hemorrhage.Methods Sixty patients with acute intracerebral hemorrhage were divided into local mild hypothermia group (30 cases) and routine therapy group (30 cases) by random digits table method.Routine therapy group was given conventional therapy,and local mild hypothermia group was given local mild hypothermia treatment besides conventional therapy.The neurologic impairment was evaluated according to American National Institute of Health Stroke Scale (NIHSS) scores on admission,and on the 3rd,7th and 14th day after treatment.Serum BNP levels in patients were determined dynamically on admission,and on the 3rd and 14th day after treatment.The effect was evaluated on the 14th day after treatment.Results There was no significant difference in serum BNP on admission between two groups (P ＞ 0.05).Serum BNP on the 3rd,14th day after treatment in local mild hypothermia group was lower than that in routine therapy group[(153.47 ± 32.01) ng/L vs.(187.45 ± 40.21)ng/L and (111.02 ± 38.27) ng/L vs.(139.71 ± 29.53) ng/L],and there was significant difference(P ＜ 0.01 or ＜ 0.05).There was no significant difference in NIHSS scores on admission and on the 3rd day after treatment between two groups (P ＞0.05).NIHSS scores on the 7th and 14th day after treatment in local mild hypothermia group was lower than that in routine therapy group [(13.84 ± 6.00) scores vs.(16.59 ± 4.62)scores and (9.23 ± 4.48) scores vs.(13.02 ± 6.76) scores],and there was significant difference (P ＜ 0.01).The total effective power in local mild hypothermia group was higher than that in routine therapy group[90.0％(27/30) vs.66.7％ (20/30)],and there was significant difference (P ＜ 0.05).Conclusions The local mild hypothermia therapy can not only significantly improve the defect of nerve function in patients with acute intracerebral hemorrhage but also reduce the serum BNP.It can improve the curative effect in patients with acute intracerebral hemorrhage.

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Objective To explore the mechanism and effect of Double-lumen Y-shaped tube treating patients with cerebral hemorrhage through irrigation and drainage at low temperature fluid.Methods Patients with cerebral hemorrhage were randomly divided into treatment group(27 cases) and control group(27 cases).All patients in two groups were treated with routine therapy and small bone flap craniotomy.Patients in control group were received treatment of single-lumen tube,while in treatment group were received treatment of double-lumen Y-shaped tube through irrigation and drainage at low temperature fluid (18-20℃).Neuron-specific enolase (NSE),tympanic temperature,NIHSS score and Barthel score were measured and analyzed respectively.Results Tympanic temperature at before treatment,2 days after treatment,l day after tube remove in treatment group were (37.6 ±0.8),(34.1 ±0.6),(37.1 ±0.6) ℃ respectively,and those in control group were (37.5 ± 0.9),(37.9 ± 1.1),(37.3 ± 0.7) ℃ respectively.NSE level and NIHSS score at pre-treatment,7th days and 14th days treatment were ((27.6 ±6.5),(21.8 ±6.1),(12.1 ±5.7)) μ,g/L,((17.8 ±4.3),(14.6±3.9),(11.1 ±3.1)) in treatment group and ((27.2 ±5.9),(29.3 ±5.6),(20.0 ±6.3)) μg/L,((17.1 ± 4.5),(16.1 ± 4.6),(15.0 ± 2.9)) in control group respectively.There were significant difference between two groups at different time(F within group =189.7,F interaction =17.12,F between group =18.41 ;F within group =53.88,F interaction =33.21,F between group =37.94 ; F within group =18.66,F interaction =12.91,F between group =13.76,P ＜0.001).Tympanic temperature reached level of mild hypothermia after 2 days in treatment group.NSE level and NIHSS score reached the lowest values after 14 days in treatment group.Barthel score after 30 days and 90 days treatment were (56.5 ± 15.3),(86.6 ± 13.9) in treatment group and (45.3 ±12.9),(72.3 ± 14.2) in control group.There were significant difference between two groups at different time (F within group =50.38,F interaction =78.53,F between group =79.92,P ＜ 0.001).Barthel score reached the highest level after 90 days in treatment group.Conclusion Dual chamber Y shape pipe application on cerebral hemorrhage after continuous low temperature washing plays the role in local mild hypothermia.Meanwhile it also can decrease the concentration of NSE,alleviate cerebral injury,and then improve the prognosis.

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Objective To determine the effect of local mild hypothermia on patients with acute cerebral infarction and ascertain its optimal therapeutic window. Methods According to the time receiving treatment, 114 patients with acute cerebral infarction were divided into group A (≤6 h), group B (6-24 h) and group C (≥ 24 h). Then, each group was subdivided into 2 groups at random: treatment group (A1, B1, C1) and control group (A2, B2, C2). Patients in the control group were subjected to such conventional therapy as anti-platelet aggregation. Patients in the treatment group were treated with local mild hypothermia (33-35 ℃ body-core temperature) for 48 h besides conventional therapy. Clinical outcomes were assessed by the National institutes of health stroke scale (NIHSS) on admission and 7, 14,30 d after treatment. Furthermore, we detected the serum level of nitrogen monoxidum (NO) and superoxide dismutasc (SOD) on admission, and 7 and 14 d after treatment. Results Compared with the control group, treatment group enjoyed significantly decreased scores of NIHSS 7, 14 and 30 d after treatment and significantly decreased level of NO 7 and 14 d after treatment (P＜0.05), but obviously increased SOD vitality 7 and 14 d after treatment (P＜0.05). No significant differences in terms of NIHSS scores, level of NO and SOD vitality were noted between group C1 and group C2 at each time point (P＞0.05). Group Al and group B1 had obviously lower scores of NIHSS than group C1 on the 7th, 14th and 30th d of treatment, and had significantly lower level of NO and obviously increased SOD vitality as compared with group C1 on the 7th and 14th d of treatment (P＜ 0.05), and group A1 enjoyed its advantage.Conclusion Early local mild hypothermia therapy can improve neurological function in patients with acute cerebral infarction. The mild hypothermia induced within 6 h may be optimal therapeutic window;mild hypothermia induced at 6-24 h is less effective and that above 24 h is non-effective.

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Objective To investigate the effect of local mild hypothermia following decompressive craniectomy on encephalocele complications in patients with craniocerebral injury.Methods Eighty-six patients with severe brain injury were performed neurosurgical decompressive craniectomy in our hospital from January 2002 to December 2009. After the surgery, 32 were given routine treatment and 54 received processing adjuvant treatment with mild hypothermia. All patients were performed Glasgow coma scale (GCS), and the levels of the intracranial pressure (ICP), cerebral perfusion pressure (CPP) and blood oxygen saturation (SaO2) were detected 12 h after the surgery but before the hypothermia treatment. The condition of encephalocele, the levels of ICP and CPP were determined 7 d after surgery. Results No significant differences on age, sex ratio, injury time, GCSscores and the levels of ICP, CPP and SaO2 before treatment with mild hypothermia were found between the conventional treatment group and the mild hypothermia treatment group (P＞0.05). Significantly lower incidence rate and degree of encephalocele, statistically lower level of ICP, but obviously higher level of CPP in the mild hypothermia treatment group were found as compared with those in the conventional treatment group 7 d after the surgery (P＜0.05). Conclusion Mild hypothermia adjunctive therapy after decompressive craniectomy can improve the level of cerebral perfusion, decrease the level of ICP and reduce the incidence rate and degree ofencephalocele, having functional benefit in the recovery of brain injury.

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Objective To investigate the effects of local mild hypothermia treatment on plasma vaso-active substance such as neuropeptide Y(NPY),neurotensin(NT),calcitonin gene-related peptide(CGRP) and endotheline(ET) in patients with acute cerebral hemorrhage. Methods 70 patients were randomly divided into two groups: local mild hypothermia group (35 patients) and routine treatment group (35 patients).Nineteen healthy persons served as control group. Routine treatment was used in the both groups, and the local mild hypothermia therapy was only used in local mild hypothermia group. NPY, NT, CGRP and ET in plasma at the 1 day, 7 days and 14 days after onset were assessed.Results The concentrations of NT, CGRP and ET in the plasma of the two group were markedly higher than control group before treatment (P

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Objective To investigate the effects of local mild hypothermia therapy on ECG QT dispersion(QTd)and myocardial zymogram in patients with acute cerebral hemorrhage.Methods 70 cases of acute cerebral hemorrhage were divided into local mild hypothermia group(35 cases)and routine treatment group(35 cases)randomly.Routine treatment was used in both groups,and the local mild hypothermia therapy was just applied in local mild hypothermia group.The changes of the ECG QTd and myocardial zymogram were observed before treatment and 1 week after treatment.Results The ECG QTd was shorten and the myocardial enzymes in serum were decreased significantly in both groups at the 1 week after treatment(P

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Objective To investigate the effect of local mild hypothermia on stress hormones in patients with acute cerebral hemorrhage.Methods 78 patients were randomly divided into two groups, mild hypothermia group (38 cases) and routine group (40 cases). Conventional treatment was used in both groups, and local mild hypothermia therapy was applied in mild hypothermia group. The concentrations of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), corticosteroid (CS) and aldosterone (ALD) in plasma pretherapy and at 3rd, 7th day after treatment were measured. The scores of clinical neurological deficit prior and at 3rd week after treatment were observed.Results The levels of plasma ACTH, CRH, CS and ALD prior treatment both in mild hypothermia and routine group were higher than those in healthy control group (all P