急性肝不全における制御不能の頭蓋内高血圧による中等度の低体温
R Jalan1, S W O Damink, N E Deutz
1Liver Unit, Royal Infirmary of Edinburgh, UK. r.jalan@ed.ac.uk
Lancet (London, England)
|October 8, 1999
まとめ
適度な低体温症は,急性肝不全患者の頭蓋内圧を効果的に低下させ,肝臓移植への潜在的な橋渡しを提供します. この治療法では,重篤な症例の治療結果を改善する見通しを示しています.
科学分野:
- 肝臓病理学 肝臓病理学
- 神経批判的ケアとは
- クリティカルケア・メディシン
背景:
- 急性肝不全 (ALF) は,特に頭蓋内圧 (ICP) の上昇によって合併された場合,高い死亡リスクをもたらします.
- マニトールや超濾過などの標準的な治療は,ALFの制御されていないICPにはしばしば不十分です.
- 新しい治療戦略の調査は,高いICPを有するALF患者の生存率を改善するために不可欠です.
研究 の 目的:
- ALF患者の制御されていないICPの管理における中程度の低体温の安全性と有効性を評価する.
- 低体温がオーソトピック肝臓移植 (OLT) への橋渡しとして機能するかどうかを判断する.
主な方法:
- 耐火性でICPが増加した7人のALF患者は,冷却毛布を使用して,中程度の低体温 (コア温度32~33°C) を受けました.
- 患者は,OLT候補性 (非候補者では8時間,候補者ではOLT前およびOLT内では8時間) に基づいて,さまざまな期間冷却されました.
- 脳の血流と代謝指数は,冷却前と冷却後の測定を行いました.
主要な成果:
- 低体温はICPを45mmHgから16mmHg (p<0.05) に大幅に低下させ,脳の血流が低下した.
- 低体温症の間,脳 perfusion 圧力は45 mm Hg から 70 mm Hg (p<0.05) に大幅に増加しました.
- 4人のOLT候補者が移植に成功し,3人の非候補者は再加熱後に死亡しました. 低体温への有害な影響は認められませんでした.
結論:
- 適度な低体温症は,ALFの制御されていないICPの安全で効果的な治療法です.
- 低体温は,重要なブリッジ療法として機能し,選択されたALF患者でOLTを可能にします.
- ALF管理における低体温の役割に関するさらなる研究が必要である.
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