Induced hypothermia for trauma: current research and practice.
Induced hypothermia for trauma: current research and practice.
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DOI：
10.1177/0885066610366919
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发表时间：
2010-07-01
影响因子：
3.1
通讯作者：
Alam, Hasan B
中科院分区：
文献类型：
--
作者：
Finkelstein, Robert A;Alam, Hasan B
以提供治疗益处为目的的低温诱导已被接受用于成人心脏骤停和新生儿缺氧缺血性脑病（HIE）的临床环境。然而，它作为创伤治疗的潜力还没有得到很好的定义。本文讨论了诱导低温（IH）的潜在益处和并发症，重点是各种类型创伤的知识和实践现状。有很好的临床前研究表明，在心脏骤停的穿透性创伤的情况下，使用心肺转流术（CPB）将体温降低到10摄氏度可能会挽救那些否则可能死亡的人，而不会引起神经系统后遗症。这项干预措施的人体试验即将开始。临床前研究表明，诱导低温可能有助于延迟昏迷的穿透性创伤患者的心脏骤停。IH有可能用于钝性创伤的病例，但尚未得到充分研究。在创伤性脑损伤（TBI）的情况下，临床试验显示出相互矛盾的结果，尽管在临床前实验中看到几乎一致的疗效。主要的研究进行了分析，并讨论了如何规范其使用和优化未来的临床试验。需要更多的临床前和临床研究来更好地确定IH在脊髓损伤中是否有作用。
Induction of hypothermia with the goal of providing therapeutic benefit has been accepted for use in the clinical setting of adult cardiac arrest and neonatal hypoxic-ischemic encephalopathy (HIE). However, its potential as a treatment in trauma is not as well defined. This review discusses potential benefits and complications of induced hypothermia (IH) with emphasis on the current state of knowledge and practice in various types of trauma. There is excellent preclinical research showing that in cases of penetrating trauma with cardiac arrest, inducing hypothermia to 10 degrees C using cardiopulmonary bypass (CPB) could possibly save those otherwise likely to die without causing neurologic sequelae. A human trial of this intervention is about to get underway. Preclinical studies suggest that inducing hypothermia may be useful to delay cardiac arrest in penetrating trauma victims who are hypotensive. There is potential for IH to be used in cases of blunt trauma, but it has not been well studied. In the case of traumatic brain injury (TBI), clinical trials have shown conflicting results, despite almost uniform efficacy seen in preclinical experiments. Major studies are analyzed and ways to standardize its use and optimize future clinical trials are discussed. More preclinical and clinical research is needed to better define whether there could be a role for IH in the case of spinal cord injuries.