Miñambres E, Holanda M S, Domínguez Artigas M J, Rodríguez Borregán J C
Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
Med Intensiva. 2008 Jun-Jul;32(5):227-35. doi: 10.1016/s0210-5691(08)70945-8.
Induced hypothermia in neurocritical patients is one of the most promising neuroprotective therapies in the last decade. Unfortunately, the promising results obtained in experimental studies have had an unequal reflection in the different diseases that affect the neurocritical patient. The use of therapeutic hypothermia is clearly established in patients with neurological deterioration after cardiac arrest. On the contrary, its use in patients with traumatic brain injury is highly controversial. There is not enough evidence in stroke and hemorrhagic patients to support its use except in clinical trials. Nowadays, the greater understanding of the pathophysiology of secondary brain damage, the go od clinical results obtained in randomized clinical trials in patients with cerebral anoxia after ventricular fibrillation and the new cooling methods that have appeared have improved the interest of hypothermia in neurocritical patients. Induced hypothermia has a role in the intensive care unit. Critical care physicians should be familiar with the physiologic effects, current indications, techniques, and complications of induced hypothermia. This review elaborates on the clinical implications of hypothermia research in traumatic brain injury, anoxic, brain injury, stroke and intracerebral hemorrhage.
对神经重症患者实施亚低温治疗是过去十年中最具前景的神经保护疗法之一。遗憾的是，实验研究中获得的令人鼓舞的结果在影响神经重症患者的不同疾病中并未得到同等体现。治疗性低温在心脏骤停后出现神经功能恶化的患者中应用已得到明确确立。相反，其在创伤性脑损伤患者中的应用极具争议。除临床试验外，在中风和出血性患者中尚无足够证据支持其使用。如今，对继发性脑损伤病理生理学的更深入理解、在心室颤动后脑缺氧患者的随机临床试验中取得的良好临床结果以及新出现的降温方法，都提高了亚低温治疗在神经重症患者中的受关注程度。亚低温治疗在重症监护病房中具有一定作用。重症监护医生应熟悉亚低温治疗的生理效应、当前适应证、技术及并发症。本综述阐述了亚低温治疗研究在创伤性脑损伤、缺氧性脑损伤、中风和脑出血中的临床意义。
