Can we further optimize therapeutic hypothermia for hypoxic-ischemic encephalopathy?  

作　　者：Anthony Davies Guido Wassink Laura Bennet Alistair J.Gunn Joanne O.Davidson 

机构地区：[1]Department of Physiology, The University of Auckland

出　　处：《Neural Regeneration Research》2019年第10期1678-1683,共6页中国神经再生研究（英文版）

基　　金：supported by The Health Research Council of New Zealand(grant No.16/003,17/601);the Marsden Fund(grant No.17-UOA232);a Sir Charles Hercus Fellowship from the Health Research Council of New Zealand(grant No.16/003)

摘　　要：Perinatal hypoxic-ischemic encephalopathy is a leading cause of neonatal death and disability.Therapeutic hypothermia significantly reduces death and major disability associated with hypoxic-ischemic encephalopathy;however,many infants still experience lifelong disabilities to movement,sensation and cognition.Clinical guidelines,based on strong clinical and preclinical evidence,recommend therapeutic hypothermia should be started within 6 hours of birth and continued for a period of 72 hours,with a target brain temperature of 33.5 ±0.5℃ for infants with moderate to severe hypoxic-ischemic encephalopathy.The clinical guidelines also recommend that infants be re warmed at a rate of 0.5℃ per hour,but this is not based on strong evidence.There are no randomized controlled trials investigating the optimal rate of rewarming after therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy.Preclinical studies of rewarming are conflicting and results were confounded by treatment with sub-optimal durations of hypothermia.In this review,we evaluate the evidence for the optimal start time,duration and depth of hypothermia,and whether the rate of rewarming after treatment affects brain injury and neurological outcomes.Perinatal hypoxic-ischemic encephalopathy is a leading cause of neonatal death and disability.Therapeutic hypothermia significantly reduces death and major disability associated with hypoxic-ischemic encephalopathy;however,many infants still experience lifelong disabilities to movement,sensation and cognition.Clinical guidelines,based on strong clinical and preclinical evidence,recommend therapeutic hypothermia should be started within 6 hours of birth and continued for a period of 72 hours,with a target brain temperature of 33.5 ±0.5℃ for infants with moderate to severe hypoxic-ischemic encephalopathy.The clinical guidelines also recommend that infants be re warmed at a rate of 0.5℃ per hour,but this is not based on strong evidence.There are no randomized controlled trials investigating the optimal rate of rewarming after therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy.Preclinical studies of rewarming are conflicting and results were confounded by treatment with sub-optimal durations of hypothermia.In this review,we evaluate the evidence for the optimal start time,duration and depth of hypothermia,and whether the rate of rewarming after treatment affects brain injury and neurological outcomes.

关 键 词：HYPOXIA-ISCHEMIA hypoxic-ischemic ENCEPHALOPATHY THERAPEUTIC HYPOTHERMIA neuroprotection THERAPEUTIC strategies randomized controlled trials animal models fetal sheep PIGLETS 

分 类 号：R[医药卫生]