Shaikh N, Malmstrom M F
Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2013 Nov 1;2012(2):81-4. doi: 10.5339/qmj.2012.2.19. eCollection 2012.
Therapeutic hypothermia (protective hypothermia) has been known to have beneficial effects since ancient times but interest was renewed after two land mark publication a decade ago. The survival as well as quality of life of post cardiac arrest patients depends on neurological outcome. Mild induced hypothermia is recommended for improving the neurological status of these patients. All acute care physician, nurses and emergency medical services personals should be aware of this approach. We report a case of post cardiac arrest that displayed improved neurological status with mild therapeutic hypothermia.
A young, female patient experienced perioperative cardiac arrest. Immediate resuscitation lead to return of spontaneous circulation in six minutes. Her post resuscitation Glasgow Coma score (GCS) was five. We induced therapeutic hypothermia-the patient required sedation and a chemical muscle relaxant. After 24 h we began slow rewarming. On day four, her GCS improved to 14, and she was extubated on day 6. She had mild cognitive disorder but was functionally independent. She was transferred to the ward on day 11 and subsequently discharged home.
Mild induced therapeutic hypothermia improves neurological status of post cardiac arrest patients; however, it had adverse effect of increased risk for infection, arrhythmia and electrolyte disorders.
治疗性低温（保护性低温）自古以来就被认为具有有益作用，但在十年前两篇具有里程碑意义的论文发表后，人们对其兴趣再度燃起。心脏骤停后患者的生存以及生活质量取决于神经学转归。推荐轻度诱导低温以改善这些患者的神经状态。所有急症护理医生、护士及急救医疗服务人员都应了解这种方法。我们报告一例心脏骤停后患者，其通过轻度治疗性低温显示神经状态得到改善。
一名年轻女性患者在围手术期发生心脏骤停。立即进行复苏，6分钟后恢复自主循环。其复苏后格拉斯哥昏迷评分（GCS）为5分。我们诱导进行治疗性低温——患者需要镇静及使用化学性肌肉松弛剂。24小时后我们开始缓慢复温。第4天，她的GCS改善至14分，第6天拔除气管插管。她有轻度认知障碍，但功能独立。第11天她被转至病房，随后出院回家。
轻度诱导治疗性低温可改善心脏骤停后患者的神经状态；然而，它有增加感染、心律失常及电解质紊乱风险的不良反应。
