Departments of Neurology, Baylor College of Medicine, McNair Campus 7200 Cambridge St., 9th Floor, MS: NB302, Houston, TX, 77030, USA.
Division of Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
Curr Neurol Neurosci Rep. 2016 Sep;16(9):78. doi: 10.1007/s11910-016-0681-2.
Mild to moderate therapeutic hypothermia (HT) has been used to alleviate intracranial hypertension in traumatic brain injury (TBI). Its main contribution is thought to be via reduction in cerebral metabolic requirement leading both to favorable oxygen/metabolic delivery-demand ratios as well as a reduction of cerebral blood volume resulting in decreased ICP. Nevertheless, HT is a clinically complex, labor-intensive procedure with numerous potential adverse effects. Furthermore, randomized controlled trials suggest either no effect or harm. These facts challenge the role of HT in TBI. We address this challenge by posing three questions that relate to the overarching value of controlling ICP, the effectiveness of HT in reducing ICP, and the benefit-risk ratio of the intervention. We conclude that HT should not be used as an "early" intervention unless as a part of a clinical trial, although it may still have a role in patients with refractory intracranial hypertension.
轻度至中度治疗性低温（HT）已被用于减轻创伤性脑损伤（TBI）中的颅内高压。其主要作用被认为是通过降低脑代谢需求，从而改善氧代谢供应比值，并减少脑血容量，从而降低颅内压。然而，HT 是一种临床复杂、劳动强度大的程序，具有许多潜在的不良反应。此外，随机对照试验表明，HT 既没有效果也没有危害。这些事实对 HT 在 TBI 中的作用提出了挑战。我们通过提出三个问题来应对这一挑战，这三个问题与控制颅内压的总体价值、HT 降低颅内压的有效性以及干预的获益风险比有关。我们的结论是，除非作为临床试验的一部分，否则 HT 不应该作为“早期”干预措施使用，尽管它在难治性颅内高压患者中仍可能有一定作用。
