切换至 "中华医学电子期刊资源库"
高级检索
中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2015, Vol. 01 ›› Issue (01) : 20 -23. doi: 10.3877/cma.j.issn.2095-9141.2015.01.006

临床研究

亚低温对脑出血患者血清中谷氨酸水平影响的临床研究
王立夫1,†(), 刘金宝1, 段睿竹1, 尹航1, 赵钊1, 李建华2, 赵晶1, 傅露1   
  1. 1.150001 哈尔滨，黑龙江省医院南岗院区脑外科
    2.150003，哈尔滨医科大学附属四院脑外科
  • 收稿日期:2014-12-01 出版日期:2015-02-15
  • 通信作者: 王立夫
  • 基金资助:
    哈尔滨市科学技术局项目(2010RFXQS030)黑龙江省自然科学基金资助项目(D0231)

Mild hypothermia affecting glutamic acid level in patient' s blood serum after cerebral hemorrhage

Lifu Wang1,†(), Jinbao Liu1, Ruizhu Duan1, Hang Yin1, Zhao Zhao1, Jianhua Li2, Jing Zhao1, Lu Fu1   

  1. 1.Department of Neurosurgery, Heilongjiang Provincial Hospital Nangang Branch, Harbin 150001, China
    2.Department of Neurosurgery, The Forth Affiliated Hospital of Harbin Medical University,Harbin 150001,China
  • Received:2014-12-01 Published:2015-02-15
  • Corresponding author: Lifu Wang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王立夫, 刘金宝, 段睿竹, 尹航, 赵钊, 李建华, 赵晶, 傅露. 亚低温对脑出血患者血清中谷氨酸水平影响的临床研究[J]. 中华神经创伤外科电子杂志, 2015, 01(01): 20-23.

Lifu Wang, Jinbao Liu, Ruizhu Duan, Hang Yin, Zhao Zhao, Jianhua Li, Jing Zhao, Lu Fu. Mild hypothermia affecting glutamic acid level in patient' s blood serum after cerebral hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2015, 01(01): 20-23.

目的

探讨亚低温对脑出血患者血清中谷氨酸水平的影响及治疗疗效。

方法

选取自2011年至2012年黑龙江省南岗医院神经外科收治的116例经头颅CT证实脑出血患者。将其按随机数字表法分成A、B两组，A组为亚低温治疗组，B组为常规治疗组，每组58例患者。A组给予亚低温冬眠疗法，使用国产HGT-200型亚低温治疗仪，在水箱中注入2 500 ml蒸馏水及95%乙醇500 ml。B组给予常规脱水、营养神经治疗。用高效液相色谱法分析两组患者入院24 h和6 d血清中谷氨酸的含量，比较其临床疗效及并发症。血清谷氨酸含量组间比较用t检验，总有效率和并发症发生率组间比较用χ2检验，以P＜0.05为差异有统计学意义。

结果

A组血清中谷氨酸含量在24 h和6 d分别低于B组，分别为24 h时(84.6±2.3)μmol/L和(104.6±3.2)μmol/L、6 d时(114.4±3.6)μmol/L 和(190.3±4.7)μmol/L，差异具有统计学意义(t=31.269、67.413，P 均＜0.05)。A 组总有效率84.48%(49/58)，死亡率8.62%(5/58)；B 组总有效率48.27%(28/58)，死亡率36.21%(21/58)，两组相比较，差异有统计学意义(χ2=17.032、12.691，P＜0.01)。A组27例，B组28例发生并发症，总并发症各组比较差异无统计学意义(χ2=1.254，P＞0.05)。

结论

亚低温可以降低脑出血患者血清谷氨酸的含量，减轻脑损伤。对脑出血患者采取亚低温治疗，能提高治疗有效率。

关键词: 脑出血, 低温，人工, 谷氨酸, 色谱法，高压液相, 疗效比较研究

Objective

To study the effect of mild hypothermia on glutamic acid level in patient’s blood serum after the cerebral hemorrhage.

Methods

We selected 116 cases of cerebral hemorrhage from 2011 to 2012 in the Department of Neurosurgery, Heilongjiang Provincal Hospital Nangang Branch, and confirmed by head CT. We divided the cases into group A (mild hypothermia treatment) and group B (conventional treatment), each group have 58 patients. Mild hypothermia treatment with domestic HGT-200 mild hypothermia therapeutic instrument were applied to the patients in group A, the tank was injected into 2 500 ml distilled water and 500 ml 95% ethanol. Only conventional treatment (trophic nerve and routine dehydration) was applied to the patients in group B.The glutamic acid level in 24 h and 6 d after admission was analyzed in patient's blood serum by the high performance liquid chromatography to compare the situation of clinical outcomes and complications.Serum glutamic acid level among groups was tested by t test,the total effective rate and the incidence of complications among groups was tested by χ2 test.

Results

The level of glutamic acid in group A was lower than that in group B at both time point of 24 h(84.6±2.6μmol/L vs 114.4±3.6μmol/L, t=31.269, P＜0.05) and 6 d(104.6±3.2μmol/L vs 190.3±4.7μmol/L, t=37.413, P＜0.05).The total effective rate of group A was 84.48% (49/58), mortality of group A was 8.62% (5/58), the total effective rate of group B was 48.27% (28/58), mortality of group B was 36.21% (21/58), the difference on both total effective rate and mortality among groups are significant (χ2=17.032、12.691，P＜0.01). Complications, 27 cases in group A and 28 cases in group B, and there was no statistical significance of difference among groups (χ2=1.254, P>0.05).

Conclusions

Mild hypothermia treatment may be an effective method to degrade the level of glutamic acid in patient's blood serum and alleviate brain injuries.The mild hypothermia therapy may improve outcomes of patients.

Key words: Cerebral hemorrhage, Hypothermia, induced, Glutamic acid, Chromatography,high pressure liquid, Comparative effectiveness research
表1 两组脑出血患者谷氨酸含量变化(µmol/L，±s)
Tab.1 The content changes of glutamic acid level between 2 groups of cerebral hemorrhage patients(Mean±SD)
组别 例数 24h 6d
A组 58 84.6±2.3 104.6±3.2
B组 58 114.4±3.6 190.3±4.7
t值 31.269 67.413
P值 0.000 0.000
表2 两组脑出血患者治疗3个月后临床疗效比较
Tab.2 The comparison of clinical effect between 2 groups of cerebral hemorrhage patients
组别 例数 恢复良好(例) 中度残疾(例) 重度残疾(例) 植物生存(例) 死亡[例(%)] 总有效率[例(%)]
A组 58 29 13 7 4 5(8.62) 49(84.48)
B组 58 11 12 5 9 21(36.20) 28(48.27)
χ 2值 12.691 17.032
P值 0.001 0.000
表3 两组脑出血患者治疗3个月后主要并发症比较
Tab.3 The comparison of complications between 2 groups of cerebral hemorrhage patients
组别 例数 肺部感染(例) 应激溃疡(例) 肾功损害(例) 肝功损害(例) 凝血异常(例) 总并发症发生率[例(%)]
A组 58 14 5 5 2 1 27(46.55)
B组 58 12 4 11 1 0 28(48.27)
χ 2值 1.254
P值 0.478
[1]
杨水泉,李玲,黄如训,等.脑出血患者血清兴奋性氨基酸水平与功能恢复的关系[J]. 中国综合临床, 2005, 21(2):120-122.
[2]
Nakashima K,Todd MM. Effects of hypothermia on the rate of excitatory amino acid release after ischemic depolarization[J].Stroke,1996,27(5):913-918.
[3]
Baker CJ, Fiore AJ, Frazzini VI, et al. Intraischemic hypothermia decreases the release of glutamate in the cores of permanent focal cerebral infarcts[J]. Neurosurgery, 1995,36(5):994-1001.
[4]
Winfree CJ, Baker CJ, Connolly ES Jr, et al. Mild hypothermia reduces penumbral glutamate levels in the rat permanent focal cerebral ischemia model[J]. Neurosurgery, 1996, 38(6):1216-1222.
[5]
Alkan T, Kahveci N, Buyukuysal L, et al. Neuroprotective effects of MK 801 and hypothermia used alone and in combination in hypoxicischemic brain injury in neonatal rats[J].Arch Physiol Biochem,2001,109(2):135-144.
[6]
Yenari M, Kitagawa K, Lyden P, et al. Metabolic down regulation: a key to successful neuroprotection?[J]. Stroke,2008,39(10):2910-2917.
[7]
Zhi D, Zhang S, Lin X. Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury[J].Surg Neurol,2003,59(5):381-385.
[8]
Fonnum F. Glutamate: a neurotransmitter in mammalian brain[J].J Neurochem,1984,42(1):1-11.
[9]
于明琨,朱斌,张光霁,等.实验性颅脑损伤脑组织氨基酸含量变化及意义[J].中华神经外科杂志,1994,10(1):34-37.
[10]
徐仁泗.兴奋性氨基酸与脑缺血损伤研究概况[J].国外医学神经病学神经外科学分册,1998,25(2):62-64.
[11]
盛宝英,乔香兰,王明礼.兴奋性氨基酸与脑梗死的临床研究[J].中国急救医学,2000,21(12):715-716.
[12]
只达石,张赛,陈荷红,等.亚低温治疗急性重型颅脑损伤的临床疗效[J].中华神经外科杂志,2000,16(4):239.
[13]
Zhao H,Asai S,Kohno T,et al.Effects of brain temperature on CBF thresholds for extracellular glutamate release and reuptake in the striatum in a rat model of graded global ischemia[J].Neuroreport,1998,9(14):3183-3188.
[14]
Mori K, Maeda M, Miyazaki M, et al. Effects of mild(33 degrees C)and moderate(29 degrees C)hypothermia on cerebral blood flow and metabolism, lactate, and extracellular glutamate in experimental head injury[J]. Neurol Res, 1998, 20(8):719-726.
[15]
Asai S, Zhao H, Takahashi Y, et al. Minimal effect of brain temperature changes on glutamate release in rat following severe global brain ischemia: a dialysis electrode study[J].Neuroreport,1998,9(17):3863-3868.
[16]
Globus MY, Ginsberg MD, Busto R. Excitotoxic index: a biochemical marker of selective vulnerability[J]. Neurosci Lett,1991,127(1):39-42.
[17]
李燕珍,陈富嫦,赵斌,等.出血性脑血管病患者血浆兴奋性氨基酸的临床研究[J]. 神经疾病与精神卫生, 2003, 3(3):183-184.
[18]
刘心刚.局部亚低温对实验性大鼠脑出血后兴奋性氨基酸及NMDAR1受体的影响[D].吉林大学硕士论文,2006.
[1] 陈镁仪, 李伊尧, 张梦圆, 许杰, 马若凡, 李登, 顾菁. 图示化自主髋关节功能评分系统的应用研究[J]. 中华关节外科杂志(电子版), 2024, 18(03): 320-328.
[2] 邵小丽, 林燕, 张玲玲, 韩亚琴. 超声引导下子宫肌瘤注射聚桂醇硬化术联合术后米非司酮治疗临床疗效分析[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 353-360.
[3] 苏永涛, 王春雷, 徐广琪, 关中正, 焦伟, 隋颖. 胫骨骨膜牵张术联合富血小板血浆对治疗糖尿病足溃疡的疗效观察[J]. 中华损伤与修复杂志(电子版), 2024, 19(03): 238-244.
[4] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[5] 鲁鑫, 杨琴, 许佳怡. 不同术式治疗恶性梗阻性黄疸疗效及对免疫功能的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 180-183.
[6] 苗楠, 宗子钰. 脑出血后继发性脑损伤与线粒体相关机制的研究进展[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 107-111.
[7] 肖增丽, 杜安琪, 孙瑶, 赵慧颖, 安友仲. 脑出血术后AKI发生的危险因素分析及预测模型建立[J]. 中华重症医学电子杂志, 2024, 10(02): 157-163.
[8] 刘国龙, 王鹏, 谭超, 杨辉, 彭菊红. 神经外科机器人辅助双通道颅内血肿清除术治疗高血压性脑出血[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 254-256.
[9] 景方坤, 周建波, 王全才, 黄海韬, 李岩峰, 徐杨熙. 神经导航引导下治疗基底节高血压脑出血的短期疗效预测[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 154-159.
[10] 董西朝, 王林林, 袁致海, 高文文. 超早期经脑沟裂入路与经脑回皮质入路显微手术治疗基底节区脑出血的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 100-105.
[11] 鲁悦, 李伟, 庄宗, 王娟, 赵鹏来, 杭春华. 脑出血继发吉兰-巴雷综合征二例报道并文献复习[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 120-123.
[12] 王栋梁, 宋海栋, 焦风, 伍刚, 仁增, 吴文博, 吴科学, 曹旭东, 翁宇. 西藏地区神经内镜辅助手术治疗基底节区脑出血的临床初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(10): 1075-1079.
[13] 穆巴拉克·伊力哈, 徐霁华, 鲁明. 急性轻型卒中微量脑出血误诊病例的临床特点及影像学表现分析[J]. 中华脑血管病杂志(电子版), 2024, 18(05): 441-445.
[14] 邓仙裕, 罗钰璇, 张溱乐, 余展鹏, 彭亮. 自发性脑出血重症患者30 d死亡风险预测模型的建立及验证[J]. 中华脑血管病杂志(电子版), 2024, 18(02): 121-128.
[15] 王永彬, 贾彦迅, 尹轶广. 神经导航结合3D重建技术引导神经内镜血肿清除术对高血压脑出血患者的影响[J]. 中华脑血管病杂志(电子版), 2024, 18(02): 153-156.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号