Hoesch Robert E, Geocadin Romergryko G
Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
Neurologist. 2007 Nov;13(6):331-42. doi: 10.1097/NRL.0b013e318154bb79.
Therapeutic hypothermia (TH) has been employed as a neuroprotective strategy for a wide array of clinical problems since the late 1940s. Animal studies have determined that the neuroprotective effect of hypothermia is pleiotropic, impacting many steps in both the ischemic cascade and reperfusion injury. Interest in the neuroprotective effects of TH for ischemic brain injury has been resurgent, fueled by both recent positive and negative clinical trials. A review of preclinical and clinical reports on TH in adult patients is provided in this article.
Animal data and several large clinical studies of mild to moderate TH (32 degrees C-34 degrees C) for global cerebral ischemia describe favorable neurologic outcomes, with few adverse effects. However, clinical implementation for global ischemia remains poor. Some animal data support a role for TH in focal cerebral ischemia, if instituted soon after the onset of ischemia, and in the setting of reperfusion. Clinical studies of TH for focal cerebral ischemia have so far been equivocal. The available data suggest that, despite sharing some common components in the ischemic cascade, focal and global cerebral ischemia are pathophysiologically disparate, and may respond to different neuroprotective strategies.
TH is a safe, effective neuroprotective strategy for global cerebral ischemia. Because of the neuroprotective efficacy of TH in adult comatose survivors of cardiac arrest, neurologists should advocate the implementation of this strategy. TH for focal ischemia is a promising therapeutic option, but requires more basic and clinical investigation.
自20世纪40年代末以来，治疗性低温（TH）已被用作针对一系列临床问题的神经保护策略。动物研究已确定低温的神经保护作用具有多效性，会影响缺血级联反应和再灌注损伤中的多个环节。近期的阳性和阴性临床试验都激发了人们对TH治疗缺血性脑损伤神经保护作用的重新关注。本文对成人患者TH的临床前和临床报告进行了综述。
动物数据以及多项关于轻度至中度TH（32摄氏度-34摄氏度）治疗全脑缺血的大型临床研究表明，神经学预后良好，不良反应较少。然而，全脑缺血的临床应用情况仍然不佳。一些动物数据支持TH在局灶性脑缺血中发挥作用，前提是在缺血发作后不久且在再灌注的情况下应用。迄今为止，TH治疗局灶性脑缺血的临床研究结果尚无定论。现有数据表明，尽管在缺血级联反应中有一些共同成分，但局灶性和全脑缺血在病理生理学上存在差异，可能对不同的神经保护策略有不同反应。
TH是一种安全、有效的全脑缺血神经保护策略。由于TH对心脏骤停成年昏迷幸存者具有神经保护作用，神经科医生应倡导实施这一策略。TH治疗局灶性缺血是一种有前景的治疗选择，但需要更多的基础和临床研究。
