Clinical Study Of Mild Hypothermia On The Patients With Massive Hemispheric Infarction

Objective: (1) To study the influence of mild hypothermia on the ICP of patients with acute massive hemispheric infarction; (2)To study the clinical effect and its safety of mild hypothermia; (3) To observe the change of blood glucose and blood lactate under mild hypothermia.Methods: All 30 patients with acute massive hemispheric infarction were randomly divided into the control group and the hypothermia group(15 patients respectively).Hypothermia was induced within 30 hours after stoke onset and maintained for 20-49 hours after the rectal temperature(RT) reached 33癈-34癈 and lasted for 17-36 hours. The ICP, blood gas values, blood electrolytes were measured before, during and after hypothermia. Meantime, blood glucose and blood lactate were measured in both groups. According to Neurological Deficit Scale (NDS), the prognosis of the two groups was evaluated at admission and 4 weeks.Results: (1)Of the 15 patients who received mild hypothermia, the initial ICP was 14.2+4.2mmHg, and maintained at 11.3+2.8mmHg.After rewarming, the mean ICP was 13.9+3.2mmHg. The elevated ICP were significantly reduced under hypothermia; (2) In comparison with control group, the hyperglycemia and raised blood lactate significantly decreased by 2.53mmol/L and 1.60mmol/L respectively in hypothermic group (P<0.05); (3) The most frequent complication of hypothermic therapy were pneumonia (51%), and it is the same with the control.Arterial hypotension was observed during hypothennic period. One patient (7%) died of irreversible hypotension; (4) Neurological outcome according to the Neurological Deficit Scale 4 weeks after stroke was significantly decreased in hypothennic group and the outcome was better than the control group (P<0.05); (5) The study also showed that elevated temperature(T>37.5C) within the first 3 days was associated with poor outcome in patients with acute stroke. Conclusions: (1) Mild hypothermia can significantly reduced the increased ICP and relieve brain edema which protect patients from brain hernia. Under hypothermia, enough cerebral perfusion pressure (CPP) can also be maintained steadily. Mild hypothermia improved the prognosis of patients with acute massive hemispheric infarction.(2)Mild hypothermia can reduce hyperglycemia and raised blood lactate after acute stoke, through which hypothermia showed protective effects.(3)After stroke onset, fever was related closely with poor outcome, so monitoring and controlling the body temperature are important for acute stroke patients. Mild hypothermia can prevent fever and avoid its damage to ischemic brain. (4) Mild hypothermia is safe and effective for acute stroke patients without severe complications, which is feasible for the further use on the patients with acute severe cerebral infarction. ICP monitoring is helpful for hypothermia treatment.