颅脑创伤亚低温治疗应重视个体化治疗

Emphasizing Individualized Hypothermia in the Treatment of Traumatic Brain Injury

颅脑创伤(TBI)的亚低温治疗开展数十年,其临床效果一直是国内外学者关注的焦点。一部分临床试验显示了亚低温治疗的良好疗效,但在权威杂志最新发表的2个Ⅲ期随机对照临床试验显示亚低温治疗对TBI无明显疗效。欧美学者分析其原因可能由于亚低温治疗的短时程造成颅内压反弹。因此,国内学者主张个体化长时程治疗方案显示出一定的优越性。TBI的病理生理复杂多变,个体差异较大,欧美随机对照临床研究所用的统一标准和固定的低温维持时间存在一定的局限性。治疗方案的个体化与否、亚低温维持的时程长短以及颅内压的控制水平,将是决定亚低温治疗的关键因素。

Mild hypothermia therapy for traumatic brain injury(TBI) has been implemented for decades and its clinical efficacy has caught great attention of scholars around world.While previous clinical trials had shown a beneficial effect of mild hypothermia therapy,most recently,two stage Ⅲ randomized clinical trials have just been published in a high impact journal and the findings of those trials suggested there was no significant benefit of hypothermia therapy on TBI patients.European and American scholars pointed out that intracranial pressure rebound under short-term hypothermia therapy might be the primary cause of the negative result in those two trials.Therefore,we and other Chinese scholars proposed that individualized extending period of hypothermia treatment may overcome the shortcomings.In the current article,we have reviewed pathophysiology of TBI and recent publications of hypothermia therapy in TBI.We think that randomized clinical trials under the European and American guidelines with generalized standard and time of hypothermia may not be suitable to every patient.Thus,here we propose individualized period of mild hypothermia and level of intracranial pressure be the key factors to determine the consequence of mild hypothermia in TBI.