Dramatic neuronal rescue with prolonged selective heed cooling after ischemia in fetal lambs
Dramatic neuronal rescue with prolonged selective heed cooling after ischemia in fetal lambs
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DOI：
10.1172/jci119153
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发表时间：
1997-01-15
影响因子：
15.9
通讯作者：
Gluckman, PD
中科院分区：
文献类型：
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作者：
Gunn, AJ;Gunn, TR;Gluckman, PD
低温已被提出作为一种神经保护策略。然而，缺氧缺血后的短期冷却只有在复苏期间立即开始才有效。本研究的目的是确定是否延长头部冷却，延迟到损伤后后期，改善严重缺血的结果。未麻醉的近足月胎羊进行30分钟的脑缺血。90 min后，将其随机分为冷却组（n = 9）和假冷却组（n = 7），持续72 h。宫内冷却是通过在胎头周围放置线圈来诱导的，最初导致硬膜外温度下降5-10 ℃，食管温度下降1.5-3 ℃。降温与轻度一过性全身代谢效应相关，但与低血压或胎心率改变无关。脑降温可减轻继发性皮质细胞毒性水肿（P < 0.001）。在恢复5天后，有更大的残留脑电图活动（-5.2+/-1.6对-15.5+/-1.5 dB，P < 0.001），并且在所有评估区域中皮质梗死和神经元损失的程度显著降低（例如，40 vs. 99%，P < 0.001）。选择性头部冷却，保持整个第二阶段的伤害，是非侵入性的和安全的，并显示出改善围产期窒息后的新生儿结局的潜力。
Hypothermia has been proposed as a neuroprotective strategy. However, short-term cooling after hypoxia-ischemia is effective only if started immediately during resuscitation. The aim of this study was to determine whether prolonged head cooling, delayed into the late postinsult period, improves outcome from severe ischemia. Unanesthetized near term fetal sheep were subject to 30 min of cerebral ischemia. 90 min later they were randomized to either cooling (n = 9) or sham cooling (n = 7) for 72 h. Intrauterine cooling was induced by a coil around the fetal head, leading initially to a fall in extradural temperature of 5-10 degrees C, and a fall in esophageal temperature of 1.5-3 degrees C. Cooling was associated with mild transient systemic metabolic effects, but not with hypotension or altered fetal heart rate. Cerebral cooling reduced secondary cortical cytotoxic edema (P < 0.001). After 5 d of recovery there was greater residual electroencephatogram activity (-5.2+/-1.6 vs. -15.5+/-1.5 dB, P < 0.001) and a dramatic reduction in the extent of cortical infarction and neuronal loss in all regions assessed (e.g., 40 vs. 99% in the parasagittal cortex, P < 0.001). Selective head cooling, maintained throughout the secondary phase of injury, is noninvasive and safe and shows potential for improving neonatal outcome after perinatal asphyxia.