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中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (05) : 310 -314. doi: 10.3877/cma.j.issn.2095-123X.2022.05.011

综述

目标体温管理对心脏骤停患者脑保护作用的研究进展
杨丽婷1, 潘东峰1, 白雪1, 张玲1, 陈梦飞1,()   
  1. 1. 750001 银川,宁夏回族自治区人民医院急诊科
  • 收稿日期:2022-03-17 出版日期:2022-10-15
  • 通信作者: 陈梦飞
  • 基金资助:
    宁夏回族自治区重点研发计划项目(2020BEG03041)

Progress in the study of the cerebral protective effect of target temperature management in cardiac arrest patients

Liting Yang1, Dongfeng Pan1, Xue Bai1, Ling Zhang1, Mengfei Chen1,()   

  1. 1. Department of Emergency Medicine, People's Hospital of Ningxia Hui Autonomous Region (the Third Clinical Medical College of Ningxia Medical University), Yinchuan 750001, China
  • Received:2022-03-17 Published:2022-10-15
  • Corresponding author: Mengfei Chen
引用本文:

杨丽婷, 潘东峰, 白雪, 张玲, 陈梦飞. 目标体温管理对心脏骤停患者脑保护作用的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(05): 310-314.

Liting Yang, Dongfeng Pan, Xue Bai, Ling Zhang, Mengfei Chen. Progress in the study of the cerebral protective effect of target temperature management in cardiac arrest patients[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(05): 310-314.

目标体温管理(TTM)是一种根据设定方案进行体温管理的治疗方法,在心脏骤停复苏成功的患者中广泛应用。近年来,关于TTM对心脏骤停患者脑保护作用的临床实践研究取得了重大进展,但也存在很大的争议。不同研究的纳入人群、采取的低温诱导技术及治疗的目标温度达标时间等条件不同,而且临床实验并不能完全模拟基础实验完整的、标准的条件,在实际应用TTM时会受到多种限制。本文围绕TTM对心脏骤停患者脑保护作用的研究进展作一综述。

Targeted temperature management (TTM) is a therapeutic approach to temperature management according to a set protocol that is widely used in patients resuscitated successfully from cardiac arrest. In recent years, there have been significant advances in clinical practice studies on the cerebral protective effects of TTM in cardiac arrest patients, while it is also controversial from many sides. Different studies have different conditions such as the inclusion population, the hypothermia induction technique adopted and the time of reaching the target temperature for treatment. Moreover, the clinical trials do not fully simulate the complete and standard conditions of the basic trials, which will be subject to various restrictions in the actual application of TTM. This article reviews the research progress of TTM on brain protection in patients with cardiac arrest.

表1 部分研究对TTM的临床效果评价
作者 文献题目 期刊 发表时间 观点 结论
Nolan等[2] Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation Resuscitation 2003年 有效 推荐将发生OHCA后自主循环恢复但意识尚未恢复患者的体温降至33~34℃、持续12~24 h
Hypothermia after Cardiac Arrest Study Group[15] Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest N Engl J Med 2002年 有效 在因心室颤动导致心脏骤停并成功复苏的患者中,TTM提高了神经系统预后并降低了死亡率
Bernard等[16] Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia N Engl J Med 2002年 有效 中度低温治疗可以改善OHCA复苏成功患者的预后
Nielsen等[17] Targeted temperature management at 33℃ versus 36℃ after cardiac arrest N Engl J Med 2013年 无效 在心脏原因引起的OHCA昏迷患者中,与36℃的目标温度相比,33℃的低温处理并没有带来益处
Nolan等[18] European resuscitation council and european society of intensive care medicine 2015 guidelines for post-resuscitation care Intensive Care Med 2015年 无效 TTM仍然很重要,但现在可以选择目标温度为36℃,而不是之前推荐的32~34℃
Dankiewicz等[19] Hypothermia versus normothermia after out-of-hospital cardiac arrest N Engl J Med 2021年 无效 在OHCA患者中,与正常温度治疗相比,靶向低温治疗并未降低6个月的死亡率
Arrich等[20] Targeted temperature management after cardiac arrest. A systematic review and meta-analysis of animal studies Resuscitation 2021年 有效 与常温相比,32~36℃范围内的TTM以及更短的冷却时间与TTM效应大小的增加独立相关
Cariou等[22] Targeted temperature management in the ICU: guidelines from a French expert panel Ann Intensive Care 2017年 有效 TTM可以增加OHCA患者远期生存率
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