Marion D W, Penrod L E, Kelsey S F, Obrist W D, Kochanek P M, Palmer A M, Wisniewski S R, DeKosky S T
Brain Trauma Research Center, University of Pittsburgh Medical Center, PA 15213-2582, USA.
N Engl J Med. 1997 Feb 20;336(8):540-6. doi: 10.1056/NEJM199702203360803.
Traumatic brain injury initiates several metabolic processes that can exacerbate the injury. There is evidence that hypothermia may limit some of these deleterious metabolic responses.
In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in 82 patients with severe closed head injuries (a score of 3 to 7 on the Glasgow Coma Scale). The patients assigned to hypothermia were cooled to 33 degrees C a mean of 10 hours after injury, kept at 32 degrees to 33 degrees C for 24 hours, and then rewarmed. A specialist in physical medicine and rehabilitation who was unaware of the treatment assignments evaluated the patients 3, 6, and 12 months later with the use of the Glasgow Outcome Scale.
The demographic characteristics and causes and severity of injury were similar in the hypothermia and normothermia groups. At 12 months, 62 percent of the patients in the hypothermia group and 38 percent of those in the normothermia group had good outcomes (moderate, mild, or no disabilities). The adjusted risk ratio for a bad outcome in the hypothermia group was 0.5 (95 percent confidence interval, 0.2 to 1.2). Hypothermia did not improve the outcomes in the patients with coma scores of 3 or 4 on admission. Among the patients with scores of 5 to 7, hypothermia was associated with significantly improved outcomes at 3 and 6 months (adjusted risk ratio for a bad outcome, 0.2; 95 percent confidence interval, 0.1 to 0.9 at both intervals), although not at 12 months (risk ratio, 0.3; 95 percent confidence interval, 0.1 to 1.0).
Treatment with moderate hypothermia for 24 hours in patients with severe traumatic brain injury and coma scores of 5 to 7 on admission hastened neurologic recovery and may have improved the outcome.
创伤性脑损伤引发多种代谢过程，可加重损伤。有证据表明低温可能会限制其中一些有害的代谢反应。
在一项随机对照试验中，我们比较了中度低温与正常体温对82例重度闭合性颅脑损伤患者（格拉斯哥昏迷量表评分为3至7分）的影响。分配到低温治疗组的患者在受伤后平均10小时被冷却至33摄氏度，在32至33摄氏度维持24小时，然后复温。一名不了解治疗分配情况的物理医学与康复专家在3个月、6个月和12个月后使用格拉斯哥预后量表对患者进行评估。
低温治疗组和正常体温治疗组的人口统计学特征、损伤原因及严重程度相似。12个月时，低温治疗组62%的患者和正常体温治疗组38%的患者预后良好（中度、轻度残疾或无残疾）。低温治疗组不良预后的校正风险比为0.5（95%置信区间为0.2至1.2）。低温治疗并未改善入院时昏迷评分为3或4分患者的预后。在昏迷评分为5至7分的患者中，低温治疗在3个月和6个月时与显著改善的预后相关（不良预后的校正风险比为0.2；两个时间点的95%置信区间均为0.1至0.9），但在12个月时并非如此（风险比为0.3；95%置信区间为0.1至1.0）。
对于重度创伤性脑损伤且入院时昏迷评分为5至7分的患者，进行24小时的中度低温治疗可加速神经功能恢复，并可能改善预后。
