Anei Ryogo, Sakai Hideki, Iihara Koji, Nagata Izumi
Department of Neurosurgery, Asahikawa Medical College, Asahikawa, Hokkaido, Japan.
Neurol Med Chir (Tokyo). 2010;50(10):879-83. doi: 10.2176/nmc.50.879.
The effectiveness of hypothermia treatment for severe subarachnoid hemorrhage (SAH) was evaluated at the same facility under the same director. A total of 187 patients with SAH, 67 admitted before the introduction of hypothermia treatment in May 1999 (early cases) and 120 treated thereafter (late cases), were transported to the National Cardiovascular Center and treated in the acute phase between November 1997 and September 2001. Brain hypothermia treatment was performed in 19 patients of the 120 late cases, 10 males and 9 females aged 33-72 years (mean 57. 6 years), treated by direct surgery in 15 and endovascular surgery in 4. The indications for hypothermia treatment were age of 75 years or younger, SAH due to rupture of a cerebral aneurysm, Japan Coma Scale score of 100 or higher, and initiation of treatment within 24 hours after the onset. The body core temperature was sustained at 34°C for 48 hours, rewarming was performed over 48 hours, and normothermia was maintained thereafter. The outcome, evaluated according to the modified Rankin scale (m-RS) on transfer to another hospital or after 3 months, was m-RS 3 in 1 patient, m-RS 4 in 4, m-RS 5 in 3, and death in 11. Before the introduction of hypothermia treatment (early period), 16 patients showed the indications for the treatment, and their outcomes were m-RS 3 in 2, m-RS 4 in 3, m-RS 5 in 2, and death in 9. Cerebral vasospasm was important as a prognostic factor, markedly deteriorating the outcome. Hyperthermia after therapeutic hypothermia induced brain swelling and markedly affecting the outcome. Brain hypothermia treatment did not improve the outcome of severe SAH compared with the period before its introduction. The emphasis in treating severe SAH should be placed on the maintenance of normothermia to prevent brain swelling and elimination of factors that may induce cerebral vasospasm, rather than interventional hypothermia for aggressive brain protection.
在同一机构、同一位主任的领导下，对亚低温治疗严重蛛网膜下腔出血（SAH）的有效性进行了评估。1997年11月至2001年9月期间，共有187例SAH患者被转运至国立心血管中心并在急性期接受治疗，其中67例在1999年5月亚低温治疗引入之前入院（早期病例），120例在此之后接受治疗（晚期病例）。在120例晚期病例中，19例接受了脑部亚低温治疗，其中男性10例，女性9例，年龄33 - 72岁（平均57.6岁），15例行直接手术治疗,4例行血管内手术治疗。亚低温治疗的指征为年龄75岁及以下、因脑动脉瘤破裂导致的SAH、日本昏迷量表评分100分及以上、发病后24小时内开始治疗。将体核心温度维持在34°C 48小时，在48小时内复温，之后维持正常体温。转至另一家医院时或3个月后，根据改良Rankin量表（m-RS）评估结果，1例m-RS为３级，4例为4级，3例为5级，11例死亡。在亚低温治疗引入之前（早期），有16例患者符合治疗指征，其结果为2例m-RS为３级，3例为4级，2例为5级，9例死亡。脑血管痉挛是一个重要的预后因素，会显著恶化预后。治疗性低温后的高热会导致脑肿胀并显著影响预后。与引入亚低温治疗之前的时期相比，脑部亚低温治疗并未改善严重SAH的预后。治疗严重SAH时应重点维持正常体温以预防脑肿胀，并消除可能诱发脑血管痉挛的因素，而不是采用介入性低温进行积极的脑保护。
