Abou-Chebl Alex, DeGeorgia Michael A, Andrefsky John C, Krieger Derk W
Section of Stroke and Neurological Critical Care, Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Neurocrit Care. 2004;1(2):131-43. doi: 10.1385/NCC:1:2:131.
To describe a technique for the induction of hypothermia and its complications for the treatment of acute ischemic stroke.
Adults with acute (<8 hours), severe (National Institutes of Health Stroke Scale>14) ischemic stroke of the anterior circulation were enrolled. Patients were intubated, sedated, and paralyzed. Surface cooling to 32 degrees+/-1 degrees C was performed with a cooling blanket and an alcohol/ice bath. Hypothermia was maintained for 12-72 hours. Physiological parameters were measured continuously. A computed tomography scan of the brain was obtained at 24 hours. Rewarming was initiated 12 hours after middle cerebral artery recanalization at a rate of 0.25 degrees C/hour. All complications and adverse outcomes were documented from initiation of hypothermia until hospital discharge.
Eighteen patients with a mean National Institutes of Health Stroke Scale=21.4+/-5.6 were treated. The goal temperature was reached within 3.2+/-1.5 hours. Cooling time was proportional to body weight (p=0.009) and decreased with immediate paralysis to prevent shivering (p=0.033). Maintenance and rewarming were characterized by fluctuations in core temperature. All patients developed a decrease in blood pressure, heart rate, and potassium values that were proportional to temperature (p<0.05). Complications were generally mild, but pneumonia and myocardial infarction or both occurred in five patients. There were trends for increased risk of complications with longer duration of hypothermia (p=0.08) and increasing age (p=0.0504). Rewarming was well-tolerated with rebound cerebral edema occurring in only one patient.
Surface cooling for the treatment of acute ischemic stroke can be performed rapidly with early neuromuscular paralysis. Advanced age and prolonged hypothermia may be associated with an increased risk of complications.
描述一种用于诱导体温过低及其并发症的技术，用于治疗急性缺血性中风。
纳入前循环急性（<8小时）、重度（美国国立卫生研究院卒中量表>14）缺血性中风的成人患者。患者接受插管、镇静和麻痹。使用降温毯和酒精/冰浴将体表温度降至32摄氏度±1摄氏度。体温过低状态维持12 - 72小时。持续测量生理参数。在24小时时进行脑部计算机断层扫描。在大脑中动脉再通后12小时开始复温，速率为每小时0.25摄氏度。记录从体温过低开始至出院的所有并发症和不良结局。
治疗了18例平均美国国立卫生研究院卒中量表评分为21.4±5.6的患者。目标温度在3.2±1.5小时内达到。降温时间与体重成正比（p = 0.009），并且因立即麻痹以防止寒战而缩短（p = 0.033）。维持和复温阶段的特征是核心体温波动。所有患者的血压、心率和钾值均下降，且与体温成比例（p<0.05）。并发症一般较轻，但5例患者发生了肺炎和心肌梗死或两者皆有。体温过低持续时间较长（p = 0.08）和年龄增加（p = 0.0504）时，并发症风险有增加趋势。复温耐受性良好，仅1例患者出现反弹性脑水肿。
急性缺血性中风治疗中的体表降温可通过早期神经肌肉麻痹快速进行。高龄和长时间体温过低可能与并发症风险增加有关。
