心脏骤停后的低温:外部冷却协议的可行性和安全性
R A Felberg1, D W Krieger, R Chuang
1Department of Neurology, Stroke Treatment Team, University of Texas-Houston Medical School, Houston, Texas, USA.
Circulation
|October 10, 2001
概括
轻度至中度诱导性低温 (MIH) 是心脏骤停患者的安全和可行的神经保护策略. 外部冷却方法有希望,但需要优化以更快,更精确的温度控制.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
背景情况:
- 心脏骤停后的缺血性脑损伤目前缺乏经过验证的神经保护疗法.
- 轻度至中度诱导性低温 (MIH) 在临床前的动物模型中已经证明了减轻此类损伤的有效性.
研究的目的:
- 评估在心脏骤停后患者中使用MIH的外部冷却毯子的安全性和可行性.
- 评估MIH协议的临床应用,包括时间和温度目标.
主要方法:
- 一项前性安全性和可行性试验,涉及9名昏迷患者,在心脏骤停后恢复自发循环.
- 包括标准侧重于及时复苏,低温开始,以及缺乏急性心肌梗塞等禁忌.
- 使用外部冷却毯子将MIH诱导到33°C,持续24小时,然后再被动加热.
主要成果:
- 在大多数情况下,MIH在90分钟内成功启动,平均时间为78分钟,从先进的心脏生命支持开始.
- 达到33°C的目标温度需要平均301分钟.
- 神经学结局包括三个完全康复和一个部分康复;一个患者经历了不稳定的心律失常,没有其他显著不良事件.
结论:
- 轻度至中度的诱导性低温是心脏骤停后患者的可行和安全的干预措施.
- 目前的外部冷却方法缓慢且缺乏精度,需要改进.
- 进一步的研究应该集中在加速冷却启动和增强冷却过程,以获得更好的临床结果.
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