心跳停止經急救復甦後的低溫治療

Therapeutic Hypothermia after Resuscitated Cardiac Arrest

吳大緯(Da-Wei Wu) ； 楊志仁(Chih-Jen Yang) ； 黃玉雰(Yu-Fen Huang) ； 蔡忠榮(Jong-Rung Tsai) ； 黃吉志(Jhi-Jhu Hwang) ； 黃明賢(Ming-Shyan Huang) ； 許超群(Chau-Chyun Sheu)

《內科學誌》 24卷6期 (2013/12) Pp. 433-445

https://doi.org/10.6314/JIMT.2013.24(6).01

摘要

國際復甦術聯合委員會在2003年首度建議所有因為心室顫動導致到院前心跳停止的病人，經急救恢復心跳但意識狀態仍然呈現昏迷時，都應該接受12－24小時，中樞體溫介於攝氏32－34度的低溫治療。到了2005年美國心臟醫學會在緊急心血管疾病照顧指引中亦提出相同的看法，同時將建議等級列為Class IIa，於2010年更進一步將建議等級提升為Class I。現今全世界有越來越多的重症醫療團隊開始進行相關的研究並且逐漸發展出適合自己團隊的低溫治療指引。本篇將就低溫治療發展史、適應症、安全性、副作用、實用指引、降溫方式等加以討論說明。

關鍵字

低溫治療（Therapeutic hypothermia, TH） ； 輕度誘導性低溫治療（Mild induced hypothermia, MIH） ； 到院前心跳停止（Out-of-hospital cardiac arrest, OHCA） ； 恢復自發性血液循環（Return of spontaneous circulation, ROSC）

並列摘要

In 2003, the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) recommended that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest (OHCA) should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF). In 2005, American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care made similar recommendations for VF arrest (Class IIa), and for non-VF arrest (Class IIb).In-hospital cardiac arrest (IHCA) patients with any initial rhythm may also benefit from therapeutic hypothermia. In 2010, the updated AHA Guidelines continue to recommend therapeutic hypothermia as the standard care for comatose post-cardiac arrest patients (Class I for VF OHCA, Class IIB for other rhythms and IHCA). The development and implementation of a feasible therapeutic hypothermia protocol is now important and urgent to critical care teams worldwide. In this article, we review the history, indications, contraindications, methods, equipments, and complications of therapeutic hypothermia. We discuss its clinical applications in non-arrest patients. We also introduce the protocol in Kaohsiung Medical University Hospital.