Choi Jae H, Pile-Spellman John
Neurological Surgery PC, Lake Success, NY, United States.
Neurological Surgery PC, Lake Success, NY, United States.
Handb Clin Neurol. 2018;157:839-852. doi: 10.1016/B978-0-444-64074-1.00052-5.
Selective brain hypothermia is a powerful concept for neuroprotection that has been successfully investigated in a variety of animal models of global and focal ischemia. Its major advantages over systemic hypothermia include rapid induction of cooling, ability to achieve profound target brain temperatures, organ-selective cooling, and temperature control. Clinical systems and devices are available or are currently under development that utilize conductive (surface-cooling pads, closed-loop catheters), convective (transnasal coolant delivery), or mass and energy transport (cold intra-arterial infusion) methods to achieve and maintain selective brain hypothermia. The "ideal" brain-cooling system that is characterized by rapid cooling to profound hypothermia, its ability to maintain selective cooling over several days, and is noninvasive in nature, remains unrealistic. Instead, systems may be identified by their distinct advantages to meet a specific need in the care of a patient. This involves the consideration of the timing of ischemic injury (preischemic, intraischemic, postischemic), extent of ischemic damage (excitotoxicity, inflammation, necrosis, edema), and type and setting of therapeutic intervention (intensive care, interventional therapy, surgery). The successful translation of these systems into clinical practice will depend on smart engineering, safety and efficacy, and usability in current clinical work flow.
选择性脑低温是一种强大的神经保护概念，已在多种全脑和局灶性缺血动物模型中得到成功研究。与全身低温相比，其主要优点包括快速诱导降温、能够达到目标脑深度温度、器官选择性降温以及温度控制。目前已有临床系统和设备，或正在开发利用传导（表面冷却垫、闭环导管）、对流（经鼻冷却剂输送）或质量与能量传输（冷动脉内输注）方法来实现和维持选择性脑低温。以快速降温至深度低温、能够在数天内维持选择性降温且本质上无创为特征的“理想”脑冷却系统仍然不现实。相反，可以根据系统的独特优势来确定其是否能满足患者护理中的特定需求。这涉及到对缺血性损伤的时间（缺血前、缺血中、缺血后）、缺血损伤的程度（兴奋性毒性、炎症、坏死、水肿）以及治疗干预的类型和背景（重症监护、介入治疗、手术）的考虑。这些系统成功转化为临床实践将取决于智能工程、安全性和有效性以及在当前临床工作流程中的可用性。
