Hindman B J, Todd M M, Gelb A W, Loftus C M, Craen R A, Schubert A, Mahla M E, Torner J C
Department of Anesthesia, University of Iowa, Iowa City 52242, USA.
Neurosurgery. 1999 Jan;44(1):23-32; discussion 32-3. doi: 10.1097/00006123-199901000-00009.
To conduct a pilot trial of mild intraoperative hypothermia during cerebral aneurysm surgery.
One hundred fourteen patients undergoing cerebral aneurysm clipping with (n = 52) (World Federation of Neurological Surgeons score < or =III) and without (n = 62) acute aneurysmal subarachnoid hemorrhage (SAH) were randomized to normothermic (target esophageal temperature at clip application of 36.5 degrees C) and hypothermic (target temperature of 33.5 degrees C) groups. Neurological status was prospectively evaluated before surgery, 24 and 72 hours postoperatively (National Institutes of Health Stroke Scale), and 3 to 6 months after surgery (Glasgow Outcome Scale). Secondary outcomes included postoperative critical care requirements, respiratory and cardiovascular complications, duration of hospitalization, and discharge disposition.
Seven hypothermic patients (12%) could not be cooled to within 1 degrees C of target temperature; three of the seven were obese. Patients randomized to the hypothermic group more frequently required intubation and rewarming for the first 2 hours after surgery. Although not achieving statistical significance, patients with SAH randomized to the hypothermic group, when compared with patients in the normothermic group, had the following: 1) a lower frequency of neurological deterioration at 24 and 72 hours after surgery (21 versus 37-41%), 2) a greater frequency of discharge to home (75 versus 57%), and 3) a greater incidence of good long-term outcomes (71 versus 57%). For patients without acute SAH, there were no outcome differences between the temperature groups. There was no suggestion that hypothermia was associated with excess morbidity or mortality.
Mild hypothermia during cerebral aneurysm surgery is feasible in nonobese patients and is well tolerated. Our results indicate that a multicenter trial enrolling 300 to 900 patients with acute aneurysmal SAH will be required to demonstrate a statistically significant benefit with mild intraoperative hypothermia.
开展一项关于脑动脉瘤手术期间轻度术中低温的试点试验。
114例接受脑动脉瘤夹闭术的患者（其中伴有急性动脉瘤性蛛网膜下腔出血（SAH）的患者52例（世界神经外科联合会评分为≤Ⅲ分），不伴有急性动脉瘤性SAH的患者62例）被随机分为常温组（夹闭时目标食管温度为36.5℃）和低温组（目标温度为33.5℃）。术前、术后24小时和72小时（采用美国国立卫生研究院卒中量表）以及术后3至6个月（采用格拉斯哥预后量表）对神经功能状态进行前瞻性评估。次要结局包括术后重症监护需求、呼吸和心血管并发症、住院时间以及出院处置情况。
7例低温组患者（12%）未能被冷却至目标温度1℃范围内；这7例患者中有3例为肥胖患者。随机分配至低温组的患者在术后最初2小时内更频繁地需要插管和复温。尽管未达到统计学显著性，但与常温组患者相比，随机分配至低温组的SAH患者有以下情况：1）术后24小时和72小时神经功能恶化的频率较低（分别为21%和37%-41%），2）出院回家的频率较高（分别为75%和57%），3）长期良好结局的发生率较高（分别为71%和57%）。对于无急性SAH的患者，不同温度组之间在结局方面无差异。没有迹象表明低温与额外的发病率或死亡率相关。
脑动脉瘤手术期间的轻度低温在非肥胖患者中是可行的，且耐受性良好。我们的结果表明，需要开展一项纳入300至900例急性动脉瘤性SAH患者的多中心试验，以证明术中轻度低温具有统计学显著益处。
