Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Stroke. 1998 Dec;29(12):2461-6. doi: 10.1161/01.str.29.12.2461.
Animal research and clinical studies in head trauma patients suggest that moderate hypothermia may improve outcome by attenuating the deleterious metabolic processes in neuronal injury. Clinical studies on moderate hypothermia in the treatment of acute ischemic stroke patients are still lacking.
Moderate hypothermia was induced in 25 patients with severe ischemic stroke in the middle cerebral artery (MCA) territory for therapy of postischemic brain edema. Hypothermia was induced within 14+/-7 hours after stroke onset and achieved by external cooling with cooling blankets, cold infusions, and cold washing. Patients were kept at 33 degreesC body-core temperature for 48 to 72 hours, and intracranial pressure (ICP), cerebral perfusion pressure, and brain temperature were monitored continuously. Outcome at 4 weeks and 3 months after the stroke was analyzed with the Scandinavian Stroke Scale (SSS) and Barthel index. The side effects of induced moderate hypothermia were analyzed.
Fourteen patients survived the hemispheric stroke (56%). Neurological outcome according to the SSS score was 29 (range, 25 to 37) 4 weeks after stroke and 38 (range 28 to 48) 3 months after stroke. During hypothermia, elevated ICP values could be significantly reduced. Herniation caused by a secondary rise in ICP after rewarming was the cause of death in all remaining patients. The most frequent complication of moderate hypothermia was pneumonia in 10 of the 25 patients (40%). Other severe side effects of hypothermia could not be detected.
Moderate hypothermia in the treatment of severe cerebral ischemia is not associated with severe side effects. Moderate hypothermia can help to control critically elevated ICP values in severe space-occupying edema after MCA stroke and may improve clinical outcome in these patients.
针对头部创伤患者的动物研究和临床研究表明，适度低温可能通过减轻神经元损伤中的有害代谢过程来改善预后。目前仍缺乏关于适度低温治疗急性缺血性脑卒中患者的临床研究。
对25例大脑中动脉（MCA）区域严重缺血性脑卒中患者进行适度低温治疗，以治疗缺血后脑水肿。在卒中发作后14±7小时内诱导低温，通过使用降温毯、冷灌注液和冷冲洗进行外部降温来实现。患者的体核温度维持在33℃达48至72小时，并持续监测颅内压（ICP）、脑灌注压和脑温。使用斯堪的纳维亚卒中量表（SSS）和巴氏指数分析卒中后4周和3个月时的预后。分析诱导适度低温的副作用。
14例患者在半球性卒中后存活（56%）。根据SSS评分，卒中后4周的神经功能预后评分为29分（范围为25至37分），卒中后3个月为38分（范围为28至48分）。在低温治疗期间，升高的ICP值可显著降低。复温后ICP继发性升高导致的脑疝是其余所有患者的死亡原因。适度低温最常见的并发症是25例患者中有10例（40%）发生肺炎。未发现低温的其他严重副作用。
适度低温治疗严重脑缺血与严重副作用无关。适度低温有助于控制MCA卒中后严重占位性水肿中严重升高的ICP值，并可能改善这些患者的临床预后。
