大脑中动脉恶性梗死性卒中患者中度低温后控制性复温的效果及可行性

Effect and feasibility of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery.

作者信息

Steiner T, Friede T, Aschoff A, Schellinger P D, Schwab S, Hacke W

机构信息

Department of Neurology, University of Heidelberg, Heidelberg, Germany.

出版信息

Stroke. 2001 Dec 1;32(12):2833-5. doi: 10.1161/hs1201.99511.

DOI:10.1161/hs1201.99511

PMID:11739982

Abstract

BACKGROUND AND PURPOSE

Moderate hypothermia has been found to reduce intracranial pressure (ICP) significantly in patients who have severe middle cerebral artery infarction. However, during passive rewarming, ICP continuously rises and some patients suffer transtentorial herniation.

METHODS

We investigated the question of whether slower rewarming leads to slower increase in ICP and slower decrease in cerebral perfusion pressure (CPP). Furthermore, we studied feasibility of slow, controlled rewarming. ICP, CPP, and core body temperature were monitored continuously. Achievement of rewarming protocol was assessed by hit rate of temperature target intervals. Side effects of hypothermia were assessed.

RESULTS

Rates of change of both ICP and CPP were correlated significantly with increase in temperature (ICP r=0.62, P=0.002; CPP r=-0.50, P=0.017). In feasibility analysis of 13 controlled rewarmed patients, hit rate of temperature target intervals was 63% (median; range 48% to 81%); hit rate within the target interval or below was 79% (median; range 62% to 94%).

CONCLUSIONS

Slow, controlled rewarming is feasible and may be used for ICP and CPP control after moderate hypothermia for space-occupying infarction.

摘要

背景与目的

已发现中度低温可显著降低大脑中动脉严重梗死患者的颅内压（ICP）。然而，在被动复温过程中，颅内压持续升高，部分患者发生小脑幕切迹疝。

方法

我们研究了较慢复温是否会导致颅内压升高减缓以及脑灌注压（CPP）下降减缓的问题。此外，我们研究了缓慢、可控复温的可行性。持续监测颅内压、脑灌注压和核心体温。通过温度目标区间的命中率评估复温方案的完成情况。评估低温的副作用。

结果

颅内压和脑灌注压的变化率均与体温升高显著相关（颅内压r = 0.62，P = 0.002；脑灌注压r = -0.50，P = 0.017）。在对13例可控复温患者的可行性分析中，温度目标区间的命中率为63%（中位数；范围48%至81%）；目标区间内或以下的命中率为79%（中位数；范围62%至94%）。