Basto Fernando Mayor, Lyden Patrick
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Handb Clin Neurol. 2018;157:823-837. doi: 10.1016/B978-0-444-64074-1.00051-3.
Therapeutic hypothermia (TH) is a potent neuroprotective therapy in experimental cerebral ischemia, with multiple effects at several stages of the ischemic cascade. In animals, TH is so powerful that all preclinical stroke studies require strict temperature control. In humans, multiple clinical studies documented powerful protection with TH after accidental neonatal hypoxic-ischemic injury and global cerebral ischemia with return of spontaneous circulation after cardiac arrest. National and international guidelines recommend TH for selected survivors of global ischemia, with profound benefits seen. Recently, a study comparing target temperature 33-36°C failed to demonstrate significant effects in cardiac arrest patients. Additionally, clinical trials of TH for head trauma and stroke have so far failed to confirm benefit in humans despite a vast preclinical literature. Therefore, it is now critical to understand the fundamental explanation for the success of TH in some, but famously not all, clinical trials. TH in animals appears to work when used soon after ischemia onset; for a short duration; and at a deep target temperature.
治疗性低温（TH）在实验性脑缺血中是一种有效的神经保护疗法，在缺血级联反应的多个阶段具有多种作用。在动物中，TH的作用非常强大，以至于所有临床前卒中研究都需要严格控制体温。在人类中，多项临床研究记录了TH在新生儿意外缺氧缺血性损伤以及心脏骤停后恢复自主循环的全脑缺血后具有强大的保护作用。国家和国际指南推荐对选定的全脑缺血幸存者采用TH治疗，已观察到显著益处。最近，一项比较目标温度为33 - 36°C的研究未能在心脏骤停患者中显示出显著效果。此外，尽管有大量临床前文献，但TH用于头部创伤和卒中的临床试验迄今为止未能证实对人类有益。因此，现在关键的是要理解TH在一些但并非所有著名的临床试验中取得成功的根本原因。在动物中，TH似乎在缺血发作后不久使用、持续时间较短且目标温度较低时起作用。
