Fan Linlin, Su Yingying, Zhang Yan, Ye Hong, Chen Weibi, Liu Gang
Department of Neurology, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
BMC Neurol. 2021 Mar 12;21(1):114. doi: 10.1186/s12883-021-02142-7.
The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI.
Patients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-h ice cap on the head for 7 days. While the DCEH group were given endovascular hypothermia (34 °C). Mortality and modified Rankin Scale (mRS) score at 6 months were evaluated.
Thirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6 months, respectively (p = 0.367). Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; p = 0.025).
There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.
Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn/showproj.aspx?proj=6854 .
低温对大脑半球大面积梗死（LHI）的影响仍存在争议。我们的研究旨在探讨减压性颅骨切除术（DC）联合低温治疗LHI的疗效。
将患者随机分为三组：DC组、DC加头部表面降温（DCSC）组和DC加血管内低温（DCEH）组。DC组维持正常体温。DCSC组头部戴冰帽24小时，共7天。而DCEH组采用血管内低温（34°C）。评估6个月时的死亡率和改良Rankin量表（mRS）评分。
本研究共纳入34例患者。DC组、DCSC组和DCEH组出院时的死亡率分别为22.2%（2/9）、0%（0/14）和9.1%（1/11）。然而，6个月时分别升至44.4%（4/9）、21.4%（3/14）和45.5%（5/11）（p = 0.367）。肺炎（8例）是出院后死亡的主要原因。12例（35.3%）患者在6个月时获得良好的神经功能结局（mRS 0 - 3）。DC组、DCSC组和DCEH组良好神经功能结局的比例分别为22.2%（2/9例）、42.9%（6/14例）和36.4%（4/11）。DCSC组似乎有更高的良好结局比例，但组间差异无统计学意义（p = 0.598）。在幸存者中，血管内低温有更高的良好结局比例（DC组，2/5例，40.0%；DCSC组，6/11例，54.5%；DCEH组，4/6例，66.7%；p = 0.696）。DCEH组的并发症发生率高于DC组和DCSC组（分别为18.9%、12.0%和12.1%；p = 0.025）。
尚无证据证实低温能进一步降低接受DC治疗的LHI患者的长期死亡率并改善神经功能结局。然而，低温对幸存者有获益趋势。局部降温方法可能是DC患者的更好选择，对全身并发症影响较小。
恶性大脑中动脉梗死减压性半颅骨切除术联合低温治疗，ChiCTR - TRC - 12002698。2012年10月11日注册 - 回顾性注册，网址：http://www.chictr.org.cn/showproj.aspx?proj = 6854 。
