The Effect Of Temperature Control On Cerebral Ischemia Reperfusion Injury After Intracranial Hematoma Removal Surgery In Patients With Severe Traumatic Brain Injury

Objective:During acute phase of7days, the severe traumatic brain injury patients with intracranial hematoma removal procedure were maintained the body temperature at rectal temperature36～37℃by manual intervention. The study aims to observe the changes of intracranial pressure and prognosis and ischemia-reperfusion injury factor IMA, MDA of patients with sTBI and to investigate whether the control temperature treatment is effective on severe traumatic brain injury patients. And further to discuss whether the cerebral protective effect of controlling body temperature is related to the mechanism of alleviating cerebral ischemia reperfusion injury after the severe traumatic brain injury patients with intracranial hematoma had been removed.Method:A total of45severe traumatic brain injury patients (3<GCS≤8on admission) with intracranial hematoma removal surgery, who conformed to the indications of mild hypothermia, were randomly divided into the therapy group (n=25)and control group(n=20).In the therapy group, mild hypothermia therapy apparatus and hibernation drugs were used to control rectal temperature at36～37℃; while in the control group, No use of mild hypothermia therapy apparatus to control body temperature. When patients with a temperature over38℃, to give drugs、 ice and other conventional cooling methods to cool. All patients in both groups were underwent Lateral ventricular puncture and drainage. All patients’intracranial pressure was measured through the lateral ventricle pressure sensor dynamically. Collecting Serum specimen on the12h after nurosurgry and on1,3,5,7days after therpy; Monitoring the ischemia-reperfusion injury related factor of serum IMA> MDA concentration; Follow-up records the GOS score of patients3months after injury; Compared the complications incidence rate of two group patients.Result:1. The comparison of intracranial pressure between two groups: Intracranial pressure is higher before treatment (12hours after surgery) between the two groups, no statistically significant differences between the two groups (P>0.05); Intracranial pressure of the two groups attained the peak at the1st day after treatment, Intracranial pressure of therapy group was significantly lower than the control group at the5th and7th day after treatment, P<0.05. The intracranial pressure elevated at12hours after surgery in therapy group, and peaked at the1st after treatment, decreased at the3th and5th day, dropped to minmum at the7th day;The intracranial pressure at the1st and3th day was significantly higher than at12hours after surgery in therapy group, P<0.05, the intracranial pressure at the5st and7th day was significantly lower than at the1st day after surgery in therapy group, P<0.05; The intracranial pressure elevated at12hours after surgery in control group, and peaked at the1st after treatment, decreased at the5th day, dropped to minmum at the7th day. The intracranial pressure at the1st and3th day was significantly higher than at12hours after surgery in control group, P<0.05, the intracranial pressure at the7th day was significantly lower than at the1st day after surgery in control group, P<0.05.2. Serum IMA concentration Compare between the two groups before and after treatment:Serum IMA concentrations of the two groups were higher before treatment, no statistically significant differences between the two groups (P>0.05); The serum IMA concentration in therapy group was significantly lower than the control group at the1st,3th,5th,7th, P<0.05. Serum IMA concentration decreased gradually at the1st,3th,5th,7th in the therapy group:the7th day was significant lower than the1st day, and compared with before treatment, there were significant difference at the1st,3th,5th,7th day, respectively, P<0.05; Serum IMA concentration decreased at the1st,3th,5th,7th in the control group, there was no significant difference at each time point, P>0.05.3. Serum MDA concentration Compare between the two groups before and after treatment:Serum MDA concentrations of the two groups were higher before treatment, no statistically significant differences between the two groups (P>0.05); The serum MDA concentration in therapy group was significantly lower than the control group at the1st,3th,5th,7th, P<0.05. Serum IMA concentration decreased gradually at the1st,3th,5th,7th in the therapy group:the5th day and the7th day was significant lower than the1st day, respectively, and compared with before treatment, there were significant difference at the3th,5th,7th day, respectively, P<0.05; Serum IMA concentration decreased slowly at the1st,3th,5th,7th in the control group, the5th day and the7th day was significant lower than the1st day, respectively, and compared with before treatment, there were significant difference at the5th,7th day, respectively, P<0.05.4. The incidence of complications between two groups:There were complications during treatment in both groups, such as arrhythmia, thrombocytopenia, pulmonary infection, hypokalemia, hypernatremia and gastrointestinal bleeding etc. The complication rate of thrombocytopenia, arrhythmia, gastrointestinal bleeding, hypokalemia, hypernatremia and pulmonary infection in therapy group is4%,8%,12%,20%,20%,32%, respevtively; The complication rate of thrombocytopenia, arrhythmia, gastrointestinal bleeding, hypokalemia, hypernatremia and pulmonary infection in control group is5%,5%,10%,20%,20%,30%, respevtively. There was no statistically significant difference in the occurrence of thrombocytopenia, arrhythmia, gastrointestinal bleeding, hypokalemia, hypernatremia and pulmonary infection between the two groups, P>0.05. 5. The comparison of GOS between therapy group and the control group:In therapy group, the proportion of good recovery and moderate disability and severe disability and vegetative state and dead was32%,36%,4%,16%,12%respectively; while that in the control group was25%,10%,35%,10%,20%respectively. In therapy group, the proportion of good prognosis and poor prognosis was68%and32%; while that in the control group was35%and65%. The comparison between two groups was statistically significant differences, P<0.05.Conclusion:1.During acute phase of3-7days, the severe traumatic brain injury patients with intracranial hematoma removal procedure are maintained the body temperature at rectal temperature36～37℃by manual intervention. By this way, intracranial pressure could be reduced effectively; the prognosis of patients could be improved.2. Traumatic brain injury patients with evacuated hematoma had ischemia-reperfusion injury, showing that serum IMA and MDA levels elevated.3. Traumatic brain injury patients with evacuated hematoma underwent body temperature control treatment could significantly decrease the concentration of IMA and MDA.4. Traumatic brain injury patients with evacuated hematoma underwent body temperature control treatment had brain protective effect, which might be related with the decrease of IMA and MDA levels, thereby alleviate cerebral ischemia reperfusion injury.