Determinants of Effective Cooling During Endovascular Hypothermia
Determinants of Effective Cooling During Endovascular Hypothermia
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DOI：
10.1007/s12028-012-9688-y
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发表时间：
2012-06-01
影响因子：
3.5
通讯作者：
Hemmen, Thomas
中科院分区：
文献类型：
--
作者：
Lyden, Patrick;Ernstrom, Karin;Hemmen, Thomas
治疗性低温是一种具有多种作用机制的有前途的神经保护疗法。我们证明了溶栓结合血管内低温的可行性，但并非所有患者都能获得有效的冷却。在26名接受血管内低温治疗的患者中，我们计算了有效冷却的四个指标：达到目标的时间;曲线下面积（AUC）34比; AUC-34;和AUC-35。通过多变量回归分析，我们研究了年龄、体重、起始体温、体重指数、体表面积（BSA）、性别、寒战和哌替啶总剂量对四个结局指标的影响。老年患者达到目标温度的时间更快（p < 0.01）。寒战和哌替啶剂量高度相关（r = 0.6，p < 0.01），两者对所有四个结局指标都有轻微影响。在多变量分析中，AUC比和达到目标温度的时间受BSA（p < 0.01）和哌替啶（p < 0.05）的显著影响; AUC-34仅受BSA（p < 0.01）的影响。AUC-35受BSA（p < 0.01）、寒战和哌替啶总剂量（p < 0.05）的影响。血管内低温期间有效冷却的最重要决定因素是BSA;体型较大的患者更难冷却并维持在治疗范围内。老年患者更快冷却。通过哌替啶、丁螺环酮和表面回温的组合可以很好地控制寒战，并且仅对冷却效果产生最小影响。未来的低温治疗试验可能包括增加措施，以更有效地冷却较大的患者。
Therapeutic hypothermia is a promising neuroprotective therapy with multiple mechanisms of action. We demonstrated the feasibility of thrombolysis combined with endovascular hypothermia, but not all patients achieved effective cooling. We sought to identify the factors that determined effective cooling.In 26 patients who underwent endovascular hypothermia, we computed four measures of effective cooling: time to reach target; Area-Under-the-Curve (AUC) 34 ratio; AUC-34; and AUC-35. By multivariate regression, we examined the effects of age, weight, starting temperature, body mass index, body surface area (BSA), gender, shivering, and total meperidine dose on the four outcome measures.In univariate analyses, all four outcome measures were significantly influenced by BSA (p < 0.01 in all univariate analyses). Time to reach target temperature was quicker in older patients (p < 0.01). Shivering and meperidine dose were highly intercorrelated (r = 0.6, p < 0.01) and both marginally influenced all four outcome measures. In multivariate analysis, AUC ratio and time to reach target temperature were significantly influenced by BSA (p < 0.01) and meperidine (p < 0.05); AUC-34 was influenced only by BSA (p < 0.01). The AUC-35 was influenced by BSA (p < 0.01), shivering, and total meperidine dose (p < 0.05).The most important determinant of effective cooling during endovascular hypothermia is BSA; larger patients are more difficult to cool and maintain in therapeutic range. Older patients cool more quickly. Shivering was well controlled by the combination of meperidine, buspirone, and surface counter-warming and only minimally influenced cooling effectiveness. Future trials of therapeutic hypothermia may include added measures to cool larger patients more effectively.