| BackgroundStroke has become one of the leading causes of death and disability at home and abroad.Large area cerebral infarction is a critical and severe disease of stroke.It has high mortality and disability rate,causing severe mental injury and heavy financial burden to patients,families and society.Therefore,it is a hot and difficult point to explore the effective treatment measures of large area cerebral infarction and reduce the mortality rate and the rate of disability.Thrombolytic therapy is an effective method for the treatment of cerebral infarction,but the strict time window(4.5H)limits its use.Bone flap decompression can significantly reduce the mortality of large area cerebral infarction,but it can not effectively improve the prognosis[1].As far as neuroprotection is concerned,no drug has been proved to be effective in clinical practice so far.Therefore,many scholars appeal to pay attention to the non drug treatment of neuroprotection,especially the mild hypothermia treatment.Since 1987 Busto for the first time from the pathology of systemic hypothermia has neuroprotective effect after a number of studies have confirmed that mild hypothermia(28-35 C)treatment group and normal treatment group compared with good neurological outcomes,can make many kinds of critically ill patients can benefit from,and by a number of guidelines recommend[2,3],Nevertheless,hypothermia treatment at home and abroad clinical application is still controversial,some doctors think the hypothermia treatment is not sufficient evidence of evidence based medicine,and quite a few doctors because of concerns about adverse reactions and not by mild hypothermia.In this study,patients within 24 hours of onset of acute large area cerebral infarction as the research object,through the treatment of patients with mild hypothermia and normal NIHSS(National Institutes of Health Stroke Scale)and mRS score(modified Rankin scale)compared to nerve functional recovery in patients with complex degree of evaluation,to observe the sub low temperature treatment of large area cerebral infarction,At the same time(Vascular endothelial growth factor)monitoring of serum vascular endothelial growth factor and tumor necrosis factor-a(Tumor necrosis factor-a,TNF-a)level changes,to explore the mechanism of hypothermia treatment from the perspective of molecular biology,to provide experimental basis for more application in clinical development for the treatment of mild hypothermia and benefit the patients.Purpose1.Observe the clinical effect of mild hypothermia in the treatment of large area cerebral infarction.2.To explore the mechanism of hypothermia on cerebral protection of large area cerebral infarction.MethodWe prospectively selected 70 patients with acute massive cerebral infarction who were hospitalized in the ICU of Henan Province People’s Hospital.They were randomly divided into mild hypothermia group and normal temperature group according to their hospitalization order.The normal temperature treatment group(35 cases):conventional treatment,mild hypothermia treatment group(35 cases):routine treatment + mild hypothermia treatment,normal control group(30 cases):neurology outpatient.1.clinical efficacy:1).NIHSS score at different time points(admission time,30d and 90d),2).Modified Rankin scale(30d and 90d)at different time points(mRS).2.,enzyme linked immunosorbent assay(ELISA)was used to determine the content of VEGF in the serum of each group.In the control group,the normal temperature treatment group was treated at the same day:1D,3D,7d and 14d after cerebral infarction,and mild hypothermia group:1D,3D,7d and 14d after cerebral infarction.3.ELISA method was used to determine the content of TNF-a in serum.The control group was treated with normal temperature at the day of treatment:1D,3D,7d and 14d after cerebral infarction,mild hypothermia group:1D,3D,7d and 14d after cerebral infarction.Result1.At 30d and 90d after onset,the NIHSS score in the mild hypothermia treatment group was significantly lower than that in the normal temperature treatment group(P<0.05).2,The mRS score of the mild hypothermia treatment group was lower than that of the normal temperature treatment group,and the difference was statistically significant(P<0.05)after 90d.3,At different time points(1D,3D,7d,14d),the VEGF content in the serum of the normal temperature treatment group was higher than that of the normal control group(P<0.01).The VEGF content in the serum of the mild hypothermia treatment group was significantly lower than that of the normal temperature treatment group(P<0.05).4,At different time points(1D,3D,7d,14d),the TNF-a content in the serum of the normal temperature treatment group was higher than that of the normal control group(P<0.01).Compared with the normal temperature treatment group,the TNF-a content in the serum of the mild hypothermia group decreased significantly(P<0.05).Conclusion1.Mild hypothermia has a protective effect on large area cerebral infarction.2.Mild hypothermia therapy can inhibit the overexpression of VEGF and TNF-a and play the role of brain protection. |
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