Hypothermiebehandlung des Schlaganfalls

Zusammenfassung

Experimentelle Studien belegen die neuroprotektiven Effekte der Hypothermiebehandlung bei fokaler, zerebraler Ischämie. Hyperthermie erwies sich in allen Studien dagegen als schädlich. Auch in klinischen Untersuchungen zeigte sich, dass die Körpertemperatur für das Outcome nach ischämischem Schlaganfall eine bedeutende Rolle spielt. Bisherige klinische Untersuchungen nach ischämischem Schlaganfall zeigen aufgrund kleiner Patientengruppen und eines nicht randomisierten Studiendesigns lediglich, dass Hypothermie beim Schlaganfall induziert werden kann und ohne schwerwiegende Nebenwirkungen ist. Bei großen, Raum fordernden sog. „malignen” Mediainfarkten konnte in verschiedenen Untersuchungen gezeigt werden, dass durch moderate Hypothermie (33°) ICP und Mortalität im Vergleich zu historischen Kontrollgruppen gesenkt werden können. In der vorliegenden Übersichtsarbeit werden die bisherigen Hypothermiestudien beim Schlaganfall, Messmethoden von Körper- und Hirntemperatur, Nebenwirkungen, Kühlmethoden, Beatmungsmodalitäten, Wiedererwärmung und Therapieoptionen zur Behandlung des Kältezitterns dargestellt und diskutiert. Der abschließende Ausblick beschäftigt sich mit den Perspektiven der Hypothermiebehandlung des ischämischen Schlaganfalls.

Abstract

Experimental studies show that hypothermia after focal cerebral ischemia is neuroprotective, while hyperthermia has the adverse effect. In accordance, increased body temperature in patients was associated with a worse outcome after ischemic stroke. Safety and feasibility of hypothermic therapy after stroke were shown, but the total patient number was rather small and the study design was neither randomized nor controlled. However, in large MCA-infarcts hypothermia was able to control elevated ICP and to reduce mortality. This review summarizes the clinical studies on hypothermia after ischemic stroke, advises for measuring brain- and body temperature, side effects of hypothermia, cooling techniques, rewarming and ventilation strategies. Moreover, future perspectives of therapeutic hypothermia in stroke are discussed.

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