Bohl Michael A, Martirosyan Nikolay L, Killeen Zachary W, Belykh Evgenii, Zabramski Joseph M, Spetzler Robert F, Preul Mark C
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
2University of Arizona College of Medicine, Phoenix, Arizona; and.
J Neurosurg. 2018 May 25;130(3):1006-1020. doi: 10.3171/2017.10.JNS171282. Print 2019 Mar 1.
Despite an overwhelming history demonstrating the potential of hypothermia to rescue and preserve the brain and spinal cord after injury or disease, clinical trials from the last 50 years have failed to show a convincing benefit. This comprehensive review provides the historical context needed to consider the current status of clinical hypothermia research and a view toward the future direction for this field. For millennia, accounts of hypothermic patients surviving typically fatal circumstances have piqued the interest of physicians and prompted many of the early investigations into hypothermic physiology. In 1650, for example, a 22-year-old woman in Oxford suffered a 30-minute execution by hanging on a notably cold and wet day but was found breathing hours later when her casket was opened in a medical school dissection laboratory. News of her complete recovery inspired pioneers such as John Hunter to perform the first complete and methodical experiments on life in a hypothermic state. Hunter's work helped spark a scientific revolution in Europe that saw the overthrow of the centuries-old dogma that volitional movement was created by hydraulic nerves filling muscle bladders with cerebrospinal fluid and replaced this theory with animal electricity. Central to this paradigm shift was Giovanni Aldini, whose public attempts to reanimate the hypothermic bodies of executed criminals not only inspired tremendous scientific debate but also inspired a young Mary Shelley to write her novel Frankenstein. Dr. Temple Fay introduced hypothermia to modern medicine with his human trials on systemic and focal cooling. His work was derailed after Nazi physicians in Dachau used his results to justify their infamous experiments on prisoners of war. The latter half of the 20th century saw the introduction of hypothermic cerebrovascular arrest in neurosurgical operating rooms. The ebb and flow of neurosurgical interest in hypothermia that has since persisted reflect our continuing struggle to achieve the neuroprotective benefits of cooling while minimizing the systemic side effects.
尽管大量历史证据表明低温疗法在损伤或疾病后拯救和保护大脑及脊髓方面具有潜力，但过去50年的临床试验却未能显示出令人信服的益处。本综述提供了审视临床低温研究现状所需的历史背景，并展望了该领域未来的发展方向。数千年来，体温过低的患者在通常致命的情况下存活的案例激发了医生的兴趣，并促使他们对低温生理学进行了许多早期研究。例如，1650年，牛津的一名22岁女子在一个特别寒冷潮湿的日子里被绞刑处决了30分钟，但数小时后当她的棺材在医学院解剖实验室被打开时，发现她仍在呼吸。她完全康复的消息激励了像约翰·亨特这样的先驱者进行了首次关于低温状态下生命的完整而系统的实验。亨特的工作引发了欧洲的一场科学革命，推翻了数百年来认为意志运动是由液压神经向肌肉囊填充脑脊液而产生的教条，并将这一理论替换为动物电理论。这场范式转变的核心人物是乔瓦尼·阿尔迪尼，他公开尝试使被处决罪犯的低温尸体复苏，这不仅引发了巨大的科学争论，还激发了年轻的玛丽·雪莱创作她的小说《科学怪人》。坦普尔·费伊博士通过对全身和局部降温的人体试验将低温疗法引入现代医学。但在达豪集中营的纳粹医生利用他的研究结果为他们对战俘进行的臭名昭著的实验辩护后，他的工作受到了阻碍。20世纪下半叶，低温脑血管停搏被引入神经外科手术室。此后神经外科对低温疗法兴趣的起伏反映了我们在实现降温的神经保护益处同时尽量减少全身副作用方面的持续努力。
