Current Development and Clinical Usage of Therapeutic Hypothermia

治療性低體溫曾因嚴重副作用而惡名昭彰，但在許多實驗室研究顯示只要溫度控制得宜，治療性低體溫是可以減少器官組織傷害的利器。在西元2002於新英格蘭雜誌上發表的兩篇隨機多中心臨床試驗報告證實了以中度到輕度低體溫可以有效幫助心因性心跳中止病患腦部的恢復並顯著減緩病患殘障，甚至增加病患的預後。在近幾年的急救指引中各方專家皆十分強調與推廣對於急救後病患使用治療性低體溫的重要。除此以外，目前在急救醫學界治療性低體溫已經被許多其他相關領域專家視為器官保護的明日之星。例如與腦部保護相關的新生兒窒息、急性腦中風、創傷性腦外傷、急性肝衰竭、急性脊椎損傷；心臟保護相關的急性心肌梗塞；多重器官衰竭相關的出血性休克與敗血症等等都有相當程度的研究與機制的瞭解，甚至已經開始進行相關臨床試驗。然而要成功以治療性低體溫幫助病患，施行治療性低體溫時需要注意費心注意許多細節。包括施用對象不同可能會有不同的施用時機與溫度、施用期間不同的差異，同時溫度控制的方法與升溫降溫速度的調整、低溫期溫控的穩定度亦與使用後是否有效以及低體溫導致的併發症息息相關。在本文中吾人對於治療性低體溫的發展與臨床應用以及臨床使用上需要注意的細節進行簡要的文獻回顧與經驗分享。

關鍵字

低治療性低體溫；心肺復甦術；急救後治療

並列摘要

Therapeutic hypothermia was first applied to clinical use in the 1940s, but was complicated by severe adverse effects at deep hypothermic temperatures. However, many animal studies have revealed that it has strong neuroprotective effects to reduce brain damage. In 2002, two multi-center randomized clinical trials which applied mild to moderate hypothermia to out-of-hospital cardiac arrest patients with cardiogenic etiologies, proved the significant benefits of the neuroprotective effect and even improvement of mortality. Currently, therapeutic hypothermia is viewed as a new strategy for organ protection in the intensive care field. Many clinical trials have examined the safety, feasibility, and efficacy of therapeutic hypothermia in different etiologies with complications with brain damage such as perinatal asphyxia, acute stroke, traumatic brain injury or acute hepatic failure with cerebral edema and spinal cord injury. Other possible applications of therapeutic hypothermia include myocardioprotection and multiple organ protection in systemic inflammatory processes such as hemorrhagic shock and sepsis. Successful application of therapeutic hypothermia depends on a sensitive, stable and etiology dependent temperature control protocol with intensive care of multiple alternative physiological and adverse effects. This is probably why therapeutic hypothermia is still not popular in Taiwan or worldwide. The aim of this study was to provide a brief review of the current use of therapeutic hypothermia in different etiologies and mechanisms, clinical management of adverse effects and the other significant physiological changes during temperature change, and some details of temperature control techniques to promote a greater understanding and usage of therapeutic hypothermia.

並列關鍵字

hypothermia ； cardiopulmonary resuscitation ； post-resuscitation care

國際替代計量

Current Development and Clinical Usage of Therapeutic Hypothermia

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