【摘要】 目的观察亚低温治疗重型颅脑损伤后血小板减少的特点。方法将本院96例重型颅脑外伤住院患者随机分成3组:选择性亚低温治疗组(脑部组)、全身亚低温治疗组(全身组)和常温组,对治疗后血小板减少及其防治措施进行分析比较。结果(1)治疗期间亚低温组(脑部组和全身组)血小板均见不同程度下降,但两组差异无显著性意义(P>0.05),并在治疗后第3天达到最低点。治疗结束后亚低温组90%(37/41)患者血小板计数在自然复温后1-2天恢复到治疗前;(2)脑部组治疗后第1、3和第5天血小板较治疗前减少约16%、27%和29%;全身组在治疗第1天减少约25%;(3)按治疗后1年的格拉斯哥预后评分(GOS)进行评估,脑部组、全身组和常温组患者恢复良好(GOS 4-5分)率分别为7/18(39%),8/23(35%)和12/15(80%),比较有显著差异(P<0.01)。结论亚低温治疗重型颅脑损伤后可发生血小板减少,而且血小板减少者预后可能较差。更多还原

【Abstract】 Objective To investigate the clinical characteristics of thrombocytopenia after treatment with hypothermia in patients with severe traumatic brain injury. Methods Twenty-seven in-patients with severe brain injury were randomly divided into three groups: SBC(selective brain cooling) group(n=24),MSH(mild systemic hypothermia) group(n=30),and control group(n=42) without any hypothermia treatment.The platelet counts were undergone and the prophylactico-therapeutic measures regarding thrombocytopenia were retrospectively analyzed. Results ①Thrombocytopenia in the hypothermia group(the SBC group and MSH group),which the minimum platelet count was detected on the 3rd day after hypothermia,was a common complication after hypothermia.There was no significant difference between the SBC group and MSH group(P>0.05);platelet counts of patients(37/41,90%) in the hypothermia group returned to the normal level in 1 to 2 days after natural rewarming.②The platelet counts in the SBC group reduced by 16%、27% and 29% on 1st,3rd and 5th day respectively after selective brain cooling compared with the baseline,while those in the mild systemic hypothermia group reduced by 25% on 1st day after mild systemic hypothermia.③Good recovery(GOS Score 4-5) rate of patients complicated with thrombocytopenia in the hypothermia group(17/41,37%) was lower than that in the control group(12/15,80%;P<0.01) after one year follow-up survey. Conclusion Thrombocytopenia after treatment with hypothermia in patients with severe traumatic brain injury is a common complication,and the patients with thrombocytopenia after therapeutic hypothermia are associated with unfavorable neurological prognosis.更多还原