Wright Joanna E
Critical Care Services, Scripps Mercy Hospital, San Diego, CA 92103, USA.
Crit Care Nurs Q. 2005 Apr-Jun;28(2):150-61. doi: 10.1097/00002727-200504000-00007.
Traumatic brain injury is a leading cause of death by trauma in adults in the United States and a major contributor to permanent physical, emotional, and psychological disabilities. Therapeutic hypothermia, defined as cooling of the body to less than 36 degrees C, has been shown to decrease mortality and morbidity and improve long-term outcomes by protecting the brain from secondary brain injury. The most commonly seen benefits of hypothermic temperatures of 32 degrees C to 33 degrees C are a significant reduction in intracranial hypertension and improved cerebral perfusion and oxygenation. Although evidence to date is insufficient to recommend the routine use of therapeutic hypothermia outside of the research setting, therapeutic hypothermia is used in multiple healthcare facilities in the world. The following article will define hypothermia and provide critical information necessary to provide care for the critically ill patient under therapeutic hypothermia. It will define the processes of brain injury and how hypothermia is thought to counteract those to protect the brain. Also included is a review of 2 major randomized, controlled trials of hypothermia for traumatic brain injury that have been instrumental in establishing guidelines and directing further research.
创伤性脑损伤是美国成年人创伤致死的主要原因，也是导致永久性身体、情感和心理残疾的主要因素。治疗性低温是指将体温降至36摄氏度以下，已被证明可降低死亡率和发病率，并通过保护大脑免受继发性脑损伤来改善长期预后。32摄氏度至33摄氏度的低温最常见的益处是显著降低颅内压，并改善脑灌注和氧合。尽管迄今为止的证据不足以推荐在研究环境之外常规使用治疗性低温，但世界上多个医疗机构都在使用治疗性低温。以下文章将定义低温，并提供在治疗性低温下为重症患者提供护理所需的关键信息。它将定义脑损伤的过程以及低温被认为如何对抗这些过程以保护大脑。还包括对两项关于创伤性脑损伤低温治疗的主要随机对照试验的综述，这些试验对制定指南和指导进一步研究起到了重要作用。
