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摘要
Object. In patients who have sustained a traumatic brain injury (TBI), hypothermia therapy has not shown efficacy in multicenter clinical trials. Armed with the post hoc data from the latest clinical trial (National Acute Brain Injury Study: Hypothermia II), the authors hypothesized that hypothermia may be beneficial in an acute subdural hematoma (SDH) rat model by blunting the effects of ischemia/reperfusion injury. The major aim of this study was to test the efficacy of temperature management in reducing brain damage after acute SDH. %26lt;br%26gt;Methods. The rats were induced with acute SDH and placed into 1 of 4 groups: 1) normothermia group (37 degrees C); 2) early hypothermia group, head and body temperature reduced to 33 degrees C 30 minutes prior to craniotomy; 3) late hypothermia group, temperature lowered to 33 degrees C 30 minutes after decompression; and 4) sham group, no acute SDH (only craniotomy with normothermia). To assess for neuronal and glial cell damage, the authors analyzed microdialysate concentrations of GFAP and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) by using a 100-kD probe. Fluoro-Jade B positive neurons and injury volume with 2,3,5-triphenyltetrazolium chloride staining were also measured. %26lt;br%26gt;Results. In the early phase of reperfusion (30 minutes, 2.5 hours after decompression), extracellular UCH-L1 in the early hypothermia group was significantly lower than in the normothermia group (early, 4.9 +/- 1.0 ng/dl; late, 35.2 +/- 12.1 ng/dl; normothermia, 50.20 +/- 28.3 ng/dl; sham, 3.1 +/- 1.3 ng/dl; early vs normothermia, p %26lt; 0.01; sham vs normothermia, p %26lt; 0.01, analyzed using ANOVA followed by a post hoc Bonferroni test). In the late phase of reperfusion (%26gt;2.5 hours after decompression), extracellular GFAP in the early hypothermia group was also lower than in the normothermia and late hypothermia groups (early, 5.5 +/- 2.9 ng/dl; late, 7.4 +/- 3.4 ng/dl; normothermia, 15.3 8.4 ng/dl; sham, 3.3 +/- 1.0 ng/dl; normothermia vs sham; p %26lt; 0.01). The number of Fluoro-Jade B positive cells in the early hypothermia group was significantly smaller than that in the normothermia group (normothermia vs early: 774,588 +/- 162,173 vs 180,903 +/- 42,212, p %26lt; 0.05). Also, the injury area and volume were smaller in the early hypothermia group in which hypothermia was induced before craniotomy and cerebral reperfusion (early, 115.2 15.4 mm(3); late, 344.7 +/- 29.1 mm(3); normothermia, 311.2 +/- 79.2 mm(3); p %26lt; 0.05). %26lt;br%26gt;Conclusions. The data suggest that early, preoperatively induced hypothermia could mediate the reduction of neuronal and glial damage in the reperfusion phase of ischemia/reperfusion brain injury. (http://thejns.org/doi/abs/10.3171/2012.10.JNS12725)
- 出版日期2013-2
