亚低温在治疗急性颅脑创伤中的疗效和争议

Effect and controversy of mild hypothermia on patients with acute traumatic brain injury

二十世纪90年代初,国内外对亚低温脑保护的作用有了新认识。动物实验研究发现亚低温对实验性颅脑外伤具有显著的治疗保护作用。大多数前瞻性临床应用研究发现30～33℃亚低温能显著降低重型颅脑伤患者的死残率。但美国Clifton教授牵头的9个医学中心合作研究发现亚低温治疗组与对照组无统计学差异.仅能显著提高GCS 6～8分、年龄<45岁、伤后6h内达到亚低温水平的病人的治疗效果。最近一项欧州5家医院多中心前瞻性随机临床研究结果令人兴奋,他们研究证明亚低温对心跳骤停脑缺血缺氧病人有显著治疗保护作用。目前国内外有关亚低温治疗的争议焦点是亚低温治疗的指征、时间窗和时程。

New recognition of cerebral protection by mild hypothermia has been found in early 90 years of 20th century. Mild hypothermia significantly reduces mortality and morbidity of traumatic brain injury in animals. Majority of prospective clinical trials have shown that 30-33℃ mild hypothermia markedly reduces mortality and morbidity of traumatic brain injured patients. However, randomised prospective clinical trial in 9 American centres headed by Clifton has not shown any effect of mild hypothermia on severe traumatic brain injured patients, only patient with GCS 6-8, <45 years old, and within 6 hours after injury. Recently, randomised prospective clinical trial in 5 European centres has confirmed that mild hypothermia significantly improves outcome of total cerebral ischemia and hypoxia caused by heart arrest without complications. The focuses of controversy now are indications, therapeutic window and duration of mild hypothermia.