Sadaka Farid, Veremakis Christopher
St. John's Mercy Medical Center, St Louis University, St Louis, MO, USA.
Brain Inj. 2012;26(7-8):899-908. doi: 10.3109/02699052.2012.661120. Epub 2012 Mar 26.
Traumatic brain injury (TBI) is a major source of death and severe disability worldwide. Raised Intracranial pressure (ICP) is an important predictor of mortality in patients with severe TBI and aggressive treatment of elevated ICP has been shown to reduce mortality and improve outcome. The acute post-injury period in TBI is characterized by several pathophysiologic processes that start in the minutes to hours following injury. All of these processes are temperature-dependent; they are all aggravated by fever and inhibited by hypothermia.
This study reviewed the current clinical evidence in support of the use of therapeutic hypothermia (TH) for the treatment of intracranial hypertension (ICH) in patients with severe TBI.
This study identified a total of 18 studies involving hypothermia for control of ICP; 13 were randomized controlled trials (RCT) and five were observational studies. TH (32-34°C) was effective in controlling ICH in all studies. In the 13 RCT, ICP in the TH group was always significantly lower than ICP in the normothermia group. In the five observational studies, ICP during TH was always significantly lower than prior to inducing TH.
Pending results from large multi-centre studies evaluating the effect of TH on ICH and outcome, TH should be included as a therapeutic option to control ICP in patients with severe TBI.
创伤性脑损伤（TBI）是全球范围内死亡和严重残疾的主要原因。颅内压升高（ICP）是重度TBI患者死亡率的重要预测指标，积极治疗ICP升高已被证明可降低死亡率并改善预后。TBI损伤后的急性期具有多种病理生理过程，这些过程在受伤后的数分钟至数小时内开始。所有这些过程都与温度有关；发热会加剧这些过程，而低温则会抑制它们。
本研究回顾了目前支持使用治疗性低温（TH）治疗重度TBI患者颅内高压（ICH）的临床证据。
本研究共确定了18项涉及低温控制ICP的研究；13项为随机对照试验（RCT），5项为观察性研究。在所有研究中，TH（32 - 34°C）对控制ICH均有效。在13项RCT中，TH组的ICP始终显著低于正常体温组。在5项观察性研究中，TH期间的ICP始终显著低于诱导TH之前。
在评估TH对ICH和预后影响的大型多中心研究结果出来之前，TH应作为控制重度TBI患者ICP的一种治疗选择。
