Abstract:

Objective To evaluate the effect of head and neck cooling（HNC）on neuron⁃specific enolase （NSE），glutamic acid（Glu）in blood and its influence on the prognosis of patients with critical traumatic brain injury （cTBI）. Methods A prospective study on 81 patients with cTBI admitted to our three intensive care units from December 2016 to October 2020，and be randomly divided into head and neck cooling group（HNC group 41）and normal ice cap cooling group（HC group 40）. At admission，24 and 72 hours after admission，venous blood was taken to detect the concentration of NSE and Glu. Glasgow Coma Scale（GCS）Score，cochlear temperature，coagu⁃ lation function，blood pressure，heart rate，shivering，and 28⁃day case fatality were monitored. At 6 months after injury，the Glasgow outcome scale（GOS）was used to assess the clinical outcome. Patients were divided into death and survival subgroups according to the 28⁃day prognosis. Results HNC for 72 hours，the concentration of NSE （56.8 ± 34.0）ng/mL was significantly lower（t = 4.390，P < 0.01）than the 24 hour′s of itself，be decreased by （12.45 ± 18.16）ng/mL，which was significantly higher（t = 3.315，P < 0.01）than that of ice cap group（-2.18 ± 21.45）ng/mL；In HNC group，24 h concentration of Glu［（185.8 ± 42.7）μmol/L］was significantly higher（t = 2.916， P < 0.01）than that of ice cap group（158.0 ± 43.1）μmol/L. 72 h Glu（160.6 ± 21.3）μmol/L showed a significant decrease（t = 4.951，P < 0.01）to the 24 hour′ s of itself，which also significantly lower than that of the ice cap group［（177.3 ± 43.2）μmol/L，t = 2.190，P < 0.05］. There was no significant difference in 28⁃ day mortality （31.7% vs. 32.5%，χ2 = 0.006，P > 0.05）between the two groups. Compare to the ice cap group，there wasn′t a difference be found in GCS scores［（7.82 ± 1.86）vs.（8.00 ± 2.60），t = 0.293，P > 0.05］at discharge. But at 6 months after injury，the GOS of the HNC group be significantly improved（41.5% vs. 20.5%，χ2 = 4.083，P < 0.05） to the HC group，and there was no significant difference in adverse reactions between the two groups. In the survival subgroup，NSE and Glu showed a more remarkable performance. In the death subgroup，HNC can′t make NSE a significant change，Glu can be significantly reduced at 72 h. Conclusion HNC for 72 hours can significantly reduce NSE of patients with cTBI，markedly decrease the concentration of Glu after a transitorily increase，and significantly improve the long⁃term prognosis of patients.

Key words:

hypothermia, induced, brain injuries, glutamic acid, phosphopyruvate hydratase