重症頭部外傷後の頭蓋内圧制御と転帰に及ぼす脳低温療法の効果

抄録

Several clinical studies and laboratory data have shown that the decrease in intracranial pressure is one of the effects of hypo­thermia for the patients with severe traumatic brain injury (TBI). Despite such evidence, it has not been shown in the clinical that hypothermia brings a significant improved outcome for the patients with TBI. In this study, we investigated the influence of hypothermia on the intracranial pressue of patients with TBI and their outcome. Fifty-three patients treated with intracranial pressure monitoring were employed in this study. Thirty-seven patients were managed with hypothermia (Hypothermia group; brain temperature 32 – 34 degrees Celsius), and 16 patients were managed at normal temperature (Normothermia group) during the treatment period following TBI. The average GCS score was 7.6±3.2 in the normothermia group, and 5.7±1.9 in the hypo­thermia group. The average age was 56.4±28.7 in the normo­thermia group, and 39.6±23.8 in the hypothermia group. Significant differences were shown in the GCS score and age between the groups. The percentages of patients with favorable outcome (GR + MD) were 50% in the normothermia group, and 51.3% in the hypothermia group. Although the difference in the outcome between the normothermia and hypothermia group was not significant statistically, however, the average intracranial pressure of patients with favorable outcome in the hypothermia group (15.9±1.2 mmHg) was higher than that of patients with favorable outcome in the normothermia group (13.9±1.6 mmHg). The outcome of the patients and the intracranial pressure of patients with favorable outcome were not significantly different however, in the hypothermia group, the patients were inclined to progress better under severe conditions in comparison with the normothermia group.