路透社脑出血后早期低温治疗能够减少


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ReutersHealthInformationEarlyHypothermiaTiedtoLessPerihemorrhagicEdemaAfterIntracerebralHemorrhageByWillBoggsMDAugust05,

NEWYORK(ReutersHealth)-Earlyinitiationofhypothermiaisassociatedwithreducedperihemorrhagicedemaafterintracerebralhemorrhage(ICH),whereashypothermiabegunmorethanthreedaysafteradmissionhaslittleeffect,researchersreport.

纽约(路透社健康频道)—研究人员报告,脑出血(ICH)后早期开始低温治疗伴随可减少出血周围水肿,而入院3天后开始低温治疗则效果有限。

"Sofaritisknownthatperihemorrhagicedemavolumeincreasesoveraperiodofupto10to14daysafteronsetofintracerebralhemorrhage(thenaturalcourseofedemaevolution),"saidDr.BastianVolbersfromtheUniversityofErlangen-Nuremberg,Germany.

德国Erlangen-Nuremberg大学的BastianVolbers医生说:“目前,我们知道ICH发生后长达10-14天出血周围水肿加重(水肿发展的自然病程)。”

"Thus,theoreticallyitmaybeassumedthattherapeutichypothermiashouldbeappliedalsoforupto10to14daystoefficientlytreatperihemorrhagicedema.However,ourdatasuggestthattherapeutichypothermiaimpactsperihemorrhagicedemaespeciallyduringthefirstfewdaysaftertheinitialbleedingevent,"hetoldReutersHealthbyemail.

“因此,理论上可以假设,治疗性低温也可以延续到10-14天,以有效治疗出血周围水肿。然而,我们的资料提示,治疗性低温仅在出血事件后最初数日内影响出血周围水肿,”他在给路透社健康频道的邮件中写到。

Mildtherapeutichypothermiareducespeakperihemorrhagicedema(PHE)volumeinICHpatientsandreduceslong-termmortalityrates,Dr.VolbersandcolleaguesnoteinStroke,onlineJuly21.Buttheoptimaltimetoinitiateandwithdrawhypothermiaremainsunclear.

轻度治疗性低温能够减少ICH患者出血周围水肿峰值(PHE)容积,并降低远期病死率,Volbers医生及其同事在7月21日Stroke在线发表的文章中写到。但是,开始及停止低温治疗的适宜时机尚不清楚。

TheresearchersexaminedtheimpactoftherapeutichypothermiatiminganddurationonPHEevolutioninaretrospectivestudyof33patientswithICHtreatedwithhypothermiaand37controlpatients(nottreatedwithhypothermia).Thirtypatientshadhypothermiainitiationonday1or2,andtheremainingthreepatientshadhypothermiainitiationonday4or5.

在纳入了接受低温治疗的33例ICH患者以及37例对照组患者(未接受低温治疗)的一项回顾性研究中,研究者验证了治疗性低温时机及疗程对PHE发展的影响。30名患者在第1天或第2天开始低温治疗,其余3名患者在第4天或第5天开始低温治疗。

Amongthepatientswithearlyhypothermiainitiation,21receivedhypothermiauptoday4to8(shortduration)and9receivedhypothermiauptoday9to15(long-duration).

在早期开始低温治疗的患者中,21例治疗持续到第4-8天(短疗程),9例治疗持续到第9-15天(长疗程)。

PHEofpatientswithearlyhypothermiainitiationdecreasedbetweenadmissionandday3,whereasitincreasedinpatientswithlatehypothermiainitiationandincontrolpatients.

从入院到第3天,早期开始低温治疗的患者PHE降低;而晚期开始低温治疗的患者以及对照组患者PHE增加。

Betweendays3and9,PHEevolutiondidnotdifferamongthethreegroups,butmedianpeakPHEwassignificantlylowerinpatientswithearlyhypothermiainitiationthanincontrols.PeakPHEdidnotdiffersignificantlybetweenpatientswithlatehypothermiainitiationandcontrols.

从第3天至第9天,PHE的发展在三组患者并无差异,但是早期开始低温治疗组PHE中位数显著低于对照组。晚期开始低温治疗组及对照组患者PHE并无显著差异。

PHEincreasedtothesameextentbetweenday3andday12inpatientswithshortandlonghypothermiadurationandcontrols.Thesamewastrueinasmallsubsetofpatientswithneuroimaginguptoday15.

短疗程与长疗程及对照组患者在第3天至第12天内PHE呈同等程度增加。有神经影像证据的患者亚组可观察到PHE增加直至第15天。

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