Abate M G, Cadore B, Citerio G
Neuroanesthesia and NeuroIntensive Care Unit, Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Milan, Italy.
Minerva Anestesiol. 2008 Jul-Aug;74(7-8):425-30. Epub 2008 Mar 21.
Therapeutic moderate hypothermia (32-34 degrees C) is currently recommended for patients with out-of-hospital cardiac arrest (OHCA) and for newborns exhibiting neonatal hypoxic/ischemic encephalopathy. Hypothermia as neuroprotective strategy has been extensively studied in other scenarios, mainly for traumatic brain injury. Despite a negative result reported by a multicenter trial conducted in 2001 by Clifton et al. regarding the use of hypothermia on head injury patients, several studies in both clinical and laboratory settings have continued to report positive outcomes with hypothermia use in neurocritical care. To date, no adequate consensus has been reached. Though the topic is still under debate, emerging data suggest that there may not be a clear-cut answer as to whether hypothermia is beneficial. However, new research may indicate what target populations can benefit most from this therapy. Furthermore, issues of timing (when and for how long hypothermia is applied) seem to be the primary drivers of the most unambiguous findings in this matter. For the time being, we conclude that further studies are needed to assess how to better administer this possibly beneficial therapy, and who might benefit most from the technique.
目前推荐对院外心脏骤停（OHCA）患者以及出现新生儿缺氧缺血性脑病的新生儿采用治疗性中度低温（32 - 34摄氏度）。低温作为一种神经保护策略已在其他情形中得到广泛研究，主要针对创伤性脑损伤。尽管2001年Clifton等人进行的一项多中心试验报告了低温治疗头部受伤患者的负面结果，但临床和实验室环境中的多项研究仍继续报告在神经重症监护中使用低温的积极结果。迄今为止，尚未达成充分的共识。尽管该话题仍在争论中，但新出现的数据表明，关于低温是否有益可能没有明确的答案。然而，新的研究可能会指出哪些目标人群能从这种治疗中获益最多。此外，时机问题（何时以及应用低温多长时间）似乎是这一问题中最明确发现的主要驱动因素。目前，我们得出结论，需要进一步研究以评估如何更好地实施这种可能有益的治疗方法，以及谁可能从该技术中获益最多。
