Clinical Study Of Local Mild Hypothermia Treatment In Intracerebral Hemorrhage

objectives: Intracerebral hemorrhage(ICH) is one of the most common and frequently-occurring diseases leading to death in neurology. It has the highest disability rate and death rate in cerebrovascular diseases. ICH always arise many complications, such as acute intracranial hypothermia, cerebral edema, stress ulcer, epiteptic seizure and cerebral hernia et al. Till now, intracerebral protecting drugs cannot interrupt the complex and serial pathological progress. Animal studies in recent years showed that mild hypothermia could protect brain tissues remarkably. Ice blanket, hibernation mixture, muscle relaxant and respirator are required in whole body hypothermia, which limits its application in clinic. We applied local mild hypothermia (LMH) to the treatment of ICH in this study. Our study aimed to (1) discuss the treatment effects of LMH on neurologic impairment scores, Barthel index, complications. (2) evaluate the effect of LMH on cerebral edema. (3)observe the dynamic effect of LMH on corticotropin-releasing hormone (CRH), adreno cortico tropic hormone (ACTH), corticosteroid (Cor), arginine vasopressin (AVP), aldosterone (ALD), superoxid dismutase (SOD), malondialdehyde (MDA)and lipid peroxidation(LPO), explore its mechanism .(4) observe its influence on blood glucose, blood hypotension, stress ulcer, renal function and electrolure, evaluate the safety of this technique.Methods: 78 ICH patients were divided into ,two groups at random; LMH group of 38 cases and regular treatment group of 40 cases, 32 health men who came from health examination center became health contrast group. Anti-encephal edema andimprovement for the metabolism of brain cells were given regularly to each group. Additionally , local mild hypothermia were given to LMH group. That was, the head of patient in this group was placed into medical hypothermia treatment machine (type YIK-1066). The temperature of ice cap was at -2—4 °C to keep the temperature of tympanic membrane at 33°C~35°C and last two to three days. Intracerebral temperature was calculated by next formula: Intracerebral temperature= tympanic membrane temperature ±0.5°C.The measurement indexes included (l)clinical effect, neurologic impairment score and evaluation to abilities of everyday life with Barthel index; (2) The volume of cerebral edema and hematom in LMH group; (3)the concentration of ACTH, CRH, ALD, AVP, MDA, SOD, LPO; (4)the comparison of variable complications and death rate, blood glucose, blood hypotension, renal functions and electrolure et al.Results: Compared with the regular therapy groups, the LMH groups manifested: (1) After 30 days of therapy, the LMH groups had a higher total efficient ratio compared with the regular therapy groups(P<0.05); The Barthel index were significantly increased compared with the regular therapy groups (P<0.01) ; After 30 days of therapy, the neurologic impairment scores of the two groups had significantly decreased, but the therapeutic effects of LMH group was better than routine treatment group(PO.Ol); (2)The volume of cerebral edema in LMH group was lighter than routine treatment group(P<0.05), but LMH did not affect the hematom volume; (3)The concentration of CRH, ACTH, Cor, ALD and AVP in serum of two groups were improved significantly at the 1st week after treatment(P<0.05), the therapeutic effects of LMH group was better than routine treatment group(P<0.05); (4) The concentration of MDA, LPO in serum of two groups were improved significantly at the 1st week after treatment(P<0.05), the therapeutic effects of LMH group was better than routine treatment group(P<0.05); The concentration of SOD in serum of two groups were increased significantly at the 1st week after treatment(P<0.05), the therapeutic effects of LMH group was better than routine treatment group(P<0.05); (5)The happen rate of complication, such as hyperglycemia, disturbance of electrolure,stress ulcer and hypotension in LMH group were better than routine treatment group(P<0.05).Conclusions:1. LMH could make the recovery of neural functions more rapidly, improve the clinical effect.2. LMH could significantly ameliorate the severity of cerebral edema, but did notaffect the hematom.3. LMH could significantly suppress the excessive excretion of HPA's hormones:CRH, ACTH, Cor, ALD AVP, decrease the excessive stree reaction4. LMH could significantly suppress the increase of MDA, LPO and promote theincrease of SOD, lighten the damage of free radicals to cerebral tissue.5. LMH could decrease the happen rate of complications: hyperglycemia, disturbanceof electrolure, stress ulcer ,and hypotension.