Chen Xi, Xu Jin, He Jiachen, Guo Jiaqi, Xu Shuaili, Yao Xuefan, Liu Yuanyuan, Xu Xiaohan, Wei Huimin, Li Ming, Wu Chuanjie, Wu Longfei, Fisher Marc, Ji Xunming, Wu Di
Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100053, China.
Department of Education, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Sci China Life Sci. 2025 May 30. doi: 10.1007/s11427-024-2738-2.
Therapeutic hypothermia (TH) is acknowledged as a promising neuroprotective strategy in clinical settings. However, its application in managing acute ischemic stroke (AIS) remains unclear due to variable clinical outcomes in bench and bedsides. A comprehensive review of original studies concerning hypothermia in ischemic stroke was conducted, sourcing data from PubMed, Web of Science, Embase, and Ovid Medicine databases covering the period from January 1, 1990 to October 31, 2023. Our search strategy yielded 1,218 articles from PubMed, 1,094 from Web of Science, 3,083 from Embase, and 2,841 from Ovid Medicine. After removing duplicates, review articles, meta-analyses, and in vitro studies focusing on hypoxic-ischemic encephalopathy or global cerebral ischemia, a total of 304 articles out of 5,669 papers were ultimately selected for in-depth analysis. Overall, we have found that there are significant differences in depth, duration, and delay between bench and bedside studies. We want to introduce the concepts of "actual brain temperature", "hypothermia initiation time", and "effective hypothermic duration" as crucial for the optimization of hypothermic therapy in AIS. We recommend critical parameters for the clinical translation of hypothermia, including a target temperature range of 34-35°C, a duration of 2-4 h, immediate initiation post-insult, and natural rewarming processes. We also advocate for selective brain cooling when reperfusion therapy is achieved. We find great differences in administrating TH for AIS between bench and bedsides. More efforts are still needed to enhance the likelihood of successful clinical translation and deepen the understanding of hypothermia's role in AIS treatment.
治疗性低温（TH）在临床环境中被认为是一种有前景的神经保护策略。然而，由于基础研究和临床研究结果存在差异，其在急性缺血性卒中（AIS）治疗中的应用仍不明确。我们对有关缺血性卒中低温治疗的原始研究进行了全面综述，从PubMed、科学网、Embase和Ovid医学数据库中获取数据，涵盖1990年1月1日至2023年10月31日期间。我们的检索策略从PubMed中获得1218篇文章，从科学网中获得1094篇，从Embase中获得3083篇，从Ovid医学数据库中获得2841篇。在去除重复文章、综述文章、荟萃分析以及专注于缺氧缺血性脑病或全脑缺血的体外研究后，最终从5669篇论文中筛选出304篇进行深入分析。总体而言，我们发现基础研究和临床研究在低温深度、持续时间和延迟方面存在显著差异。我们想引入“实际脑温”“低温开始时间”和“有效低温持续时间”的概念，这些对于优化AIS低温治疗至关重要。我们推荐低温治疗临床转化的关键参数，包括目标温度范围为34 - 35°C、持续时间为2 - 4小时、损伤后立即开始以及自然复温过程。我们还主张在实现再灌注治疗时进行选择性脑冷却。我们发现基础研究和临床研究在AIS低温治疗的实施方面存在很大差异。仍需要更多努力来提高临床转化成功的可能性，并加深对低温在AIS治疗中作用的理解。
