Bandschapp Oliver, Iaizzo Paul A
Departments of Surgery, Anesthesiology, and Integrative Biology and Physiology, University of Minnesota , Minneapolis, Minnesota.
Ther Hypothermia Temp Manag. 2011;1(2):77-85. doi: 10.1089/ther.2010.0010. Epub 2011 May 11.
Hypothermia has been linked to beneficial neurologic outcomes in different clinical situations and its therapeutic value is considered important. For example, in asphyctic neonates and in patients with out-of-hospital cardiac arrest (with ventricular fibrillation as the initial cardiac rhythm), rapid installation of hypothermia has been reported to add substantial therapeutic benefits over nonthermal standard treatments. Yet, in other groups of patients in which the application of therapeutic hypothermia may be applied with clinical benefits, the optimization of therapy remains less straightforward, as the body possesses vigorous defense mechanisms to protect it from inducing hypothermia, that is, especially in conscious patients and/or in those in which the hypothalamus remains intact, such as stroke patients or patients who suffer a myocardial infarction or spinal cord injury. This overview summarizes the body's primary reactions to hypothermia and the defense mechanisms available or evoked. Then, clinically applicable ways to overcome these forceful cold defenses of the body are described to ensure both an optimal induction process for therapeutic hypothermia and maximal subjective comfort for these conscious patients.
体温过低在不同临床情况下已被证明与良好的神经学预后相关，其治疗价值被认为很重要。例如，在窒息新生儿和院外心脏骤停患者（初始心律为心室颤动）中，据报道，快速实施低温治疗比非热标准治疗具有显著的治疗益处。然而，在其他可能从治疗性低温治疗中获益的患者群体中，治疗的优化仍然不那么直接，因为身体具有强大的防御机制来防止体温过低，也就是说，特别是在意识清醒的患者和/或下丘脑保持完整的患者中，如中风患者、心肌梗死患者或脊髓损伤患者。本综述总结了身体对体温过低的主要反应以及可用或诱发的防御机制。然后，描述了临床上克服身体这些强大冷防御的方法，以确保治疗性低温治疗的最佳诱导过程，并为这些意识清醒的患者提供最大的主观舒适度。
