THE USE OF MODERATE THERAPEUTIC HYPOTHERMIA FOR PATIENTS WITH SEVERE HEAD-INJURIES - A PRELIMINARY-REPORT
THE USE OF MODERATE THERAPEUTIC HYPOTHERMIA FOR PATIENTS WITH SEVERE HEAD-INJURIES - A PRELIMINARY-REPORT
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DOI：
10.3171/jns.1993.79.3.0354
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发表时间：
1993-09-01
影响因子：
4.1
通讯作者：
DARBY, JM
中科院分区：
文献类型：
--
作者：
MARION, DW;OBRIST, WD;DARBY, JM
动物研究表明，中度低温治疗可能会改善严重脑损伤后的预后，但其疗效尚未在人类中确立。作者将40例连续治疗的重度闭合性颅脑损伤（格拉斯哥昏迷量表评分3 - 7）患者随机分为低温组和常温组。使用冷却毯和冷盐水洗胃，低温组的患者在受伤后平均10小时内冷却至32度至33度C（脑温），保持在该温度24小时，并在12小时内复温至37度至38度C。常温组的患者在此期间维持在37度至38度C。直接监测脑深部温度，并用于所有温度测定。所有患者的颅内压（ICP）、脑血流量（CBF）和脑氧代谢率（CMRO 2）在降温期间均显著降低（40%），CBF降低（26%），复温后两项指标均无明显回升。与常温组相比，低温组的平均CMRO 2在冷却期间较低，在损伤后5天较高。损伤后3个月，低温组20名患者中有12名出现中度、轻度或无残疾;常温组20名患者中有8名改善到相同程度。两组的全身并发症发生率相似，包括心律失常、凝血功能障碍和肺部并发症。结论：亚低温治疗对重型闭合性颅脑损伤所致的急性脑生理代谢紊乱是安全的，并具有持续的良好疗效。低温治疗预后更好的趋势可能表明其有益的生理和代谢作用限制了继发性脑损伤。
Animal research suggests that moderate therapeutic hypothermia may improve outcome after a severe head injury, but its efficacy has not been established in humans. The authors randomly assigned 40 consecutively treated patients with a severe closed head injury (Glasgow Coma Scale score 3 to 7) to either a hypothermia or a normothermia group. Using cooling blankets and cold saline gastric lavage, patients in the hypothermia group were cooled to 32-degrees to 33-degrees-C (brain temperature) within a mean of 10 hours after injury, maintained at that temperature for 24 hours, and rewarmed to 37-degrees to 38-degrees-C over 12 hours. Patients in the normothermia group were maintained at 37-degrees to 38-degrees-C during this time. Deep-brain temperatures were monitored directly and used for all temperature determinations. Intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate for oxygen (CMRO2) were measured serially for all patients.Hypothermia significantly reduced ICP (40%) and CBF (26%) during the cooling period, and neither parameter showed a significant rebound increase after patients were rewarmed. Compared to the normothermia group, the mean CMRO2 in the hypothermia group was lower during cooling and higher 5 days after injury. Three months after injury, 12 of the 20 patients in the hypothermia group had moderate, mild, or no disabilities; eight of the 20 patients in the normothermia group had improved to the same degree. Both groups had a similar incidence of systemic complications, including cardiac arrhythmias, coagulopathies, and pulmonary complications. It is concluded that therapeutic moderate hypothermia is safe and has sustained favorable effects on acute derangements of cerebral physiology and metabolism caused by severe closed head injury. The trend toward better outcome with hypothermia may indicate that its beneficial physiological and metabolic effects limit secondary brain injury.