血管内低温治疗大面积脑梗死的初步观察

目的探讨血管内低温治疗大面积脑梗死的可行性和可操作性。方法对5例大面积脑梗死患者在症状出现48h内行血管内低温治疗，通过血管内热交换系统控制患者核心体温（膀胱温度）。这一过程包括诱导低温（目标温度为33～34℃）、维持低温（维持目标温度24h）和恢复常温（24h恢复至36．5℃），同时监测低温期间的不良事件。低温治疗后3个月采用改良Rankin评分（mRS）进行预后评估。结果①4例患者诱导低温时间中位数为6．5h（3．5—12．5h）。1例患者因寒战控制不理想而未能达到目标温度。②3例患者低温持续24h；1例患者因纠正脑疝而延长至48h。低温期间，3例患者核心体温最大偏差〈1℃；另1例患者核心体温最大偏差〈2℃，但温度偏差〈0．3℃时间占低温全程的80％-90％。③3例患者复温持续24h，1例患者复温持续13．5h。④低温期间非严重性不良事件共14件，2例低温前即形成脑疝的患者死亡。⑤3例存活患者低温治疗后3个月mRS分别为4、5、5分。结论血管内低温可操作性强，持续低温稳定、复温可控性强。低温期间未发生严重不良事件，但其有效性尚需大样本的临床试验加以证实。

Endovascular hypothermia for massive cerebral infarction: a preliminary observation

Objective To investigate the feasibility and operability of endovascular hypothermia for treatment of massive cerebral infarction. Methods Five patients with massive cerebral infarction were treated with endovascular hypothermia within 48 hours after onset. The core temperature （ bladder temperature） of the patients was controlled by the endovaseular heat exchange system. The process included inducing hypothermia （target temperatures were 33℃ to 34℃）, maintaining hypothermia （maintaining target temperature for 24 hours）, and rewarming to normal temperature （reaching 36. 5℃ within 24 hours）. The adverse events were monitored simultaneously during the course of hypothermia treatment. The modified Rankin scale （mRS） was used to evaluate the prognosis 3 months after the hypothermia treatment. Results The median duration of inducing hypothermia was 6.5 hours （ range 3.5 to 12.5 hours） in the 4 patients. The other patient did not reach the target temperature because of the unsatisfactory control of chill. （2）The duration of hypothermia was 24 hours in 3 patients, and one patient was extended to 48 hours because of correcting the cerebral hernia. During hypothermia, the maximum deviation of core temperature was 〈 1 ℃ in 3 patients, and in the other patient was 〈 2 ℃, however, the time of temperature devia- tion 〈 0.3℃ accounted for 80% -90% of the whole hypothermie period. （3）The rewarming continued for 24 hours in 3 patients, and in 1 patient continued for 13.5 hours; there were 14 adverse events occurred during hypothermia, and 2 patients with cerebral hernia were died before hypothermia was initiated. The mRS scores of the other 3 survivors were 4, 5, and 5 respectively at 3 months after hypothermic treatment. Conclusions Endovascular hypothermia is easy to operate, sustained hypothermia is stable, and rewarm- ing is easy to control. No serious adverse events occurred during hypothermia; however, a large-scale clinical trial is needed to demonstrate its effectiveness.