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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Dr. Rainer Kollmar
Neurologische Klinik · Universität Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Email: Rainer_Kollmar@med.uni-heidelberg.de
