重症くも膜下出血患者に対する血管内冷却カテーテルによる体温管理の可能性と安全性について ─低体温療法から復温後の常温管理に関する初期経験
「はじめに」くも膜下出血 (subarachnoid hemorrhage : SAH) 患者において, 発熱は感染の有無によらず頻繁にみられ, 転帰不良と死亡率の増加に関連することがメタアナリシスで示されている. また, 発熱は出血量の多寡や感染の有無によらず症候性脳血管攣縮の発生頻度と転帰不良に関連する. マイクロダイアリシスを用いた研究では, 発熱が代謝ストレスと関連することが示されている. 積極的な常温管理がSAH患者の転帰改善に寄与したとの報告がみられるが, 一方で血管内冷却法による体温管理が合併症増加をもたらしたとの報告もある. 当施設では院内倫理委員会の承認のもと, World...
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| Published in | 脳卒中の外科 Vol. 45; no. 6; pp. 445 - 450 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2017
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.45.445 |
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| Abstract | 「はじめに」くも膜下出血 (subarachnoid hemorrhage : SAH) 患者において, 発熱は感染の有無によらず頻繁にみられ, 転帰不良と死亡率の増加に関連することがメタアナリシスで示されている. また, 発熱は出血量の多寡や感染の有無によらず症候性脳血管攣縮の発生頻度と転帰不良に関連する. マイクロダイアリシスを用いた研究では, 発熱が代謝ストレスと関連することが示されている. 積極的な常温管理がSAH患者の転帰改善に寄与したとの報告がみられるが, 一方で血管内冷却法による体温管理が合併症増加をもたらしたとの報告もある. 当施設では院内倫理委員会の承認のもと, World Federation of Neurological Surgeons (WFNS) grade VのSAH患者に対して, 体表冷却法により来院直後より33.5℃の低体温療法 (therapeutic hypothermia : TH) ・脳動脈瘤根治術を試みてきた. |
|---|---|
| AbstractList | 「はじめに」くも膜下出血 (subarachnoid hemorrhage : SAH) 患者において, 発熱は感染の有無によらず頻繁にみられ, 転帰不良と死亡率の増加に関連することがメタアナリシスで示されている. また, 発熱は出血量の多寡や感染の有無によらず症候性脳血管攣縮の発生頻度と転帰不良に関連する. マイクロダイアリシスを用いた研究では, 発熱が代謝ストレスと関連することが示されている. 積極的な常温管理がSAH患者の転帰改善に寄与したとの報告がみられるが, 一方で血管内冷却法による体温管理が合併症増加をもたらしたとの報告もある. 当施設では院内倫理委員会の承認のもと, World Federation of Neurological Surgeons (WFNS) grade VのSAH患者に対して, 体表冷却法により来院直後より33.5℃の低体温療法 (therapeutic hypothermia : TH) ・脳動脈瘤根治術を試みてきた. |
| Author | 杉江, 亮 川上, 真樹子 荻田, 誠司 二村, 元 小畑, 仁司 |
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| References | 13) Kuramatsu JB, Kollmar R, Gerner ST, et al : Is hypothermia helpful in severe subarachnoid hemorrhage? An exploratory study on macrovascurar spasm, delayed cerebral infarction and functional outcome after prolonged hypothermia. Cerebrovasc Dis 40: 228-235, 2015 16) Oddo M, Frangos S, Milby A, et al : Induced normothermia attenuates cerebral metabolic distress in patients with aneurysmal subarachnoid hemorrhage and refractory fever. Stroke 40: 1913-1916, 2009 20) Schmutzhard E, Engelhardt K, Beer R, et al : Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 30: 2481-2488, 2002 3) Badjatia N, Strongilis E, Gordon E, et al : Metabolic impact of shivering during therapeutic temperature modulation. The bedside shivering assessment scale. Stroke 39: 3242-3247, 2008 14) Müller A, Lorenz A, Seifert B, et al : Risk of thromboembolic events with endovascular cooling catheters in patients with subarachnoid hemorrhage. Neurocrit Care 21: 207-210, 2014 11) 小畑仁司，田中英夫，多田裕一，ほか：最重症くも膜下出血に対する可及的早期脳低温療法は有用か．日救急医会誌 12:669-679, 2001 19) Scaravilli V, Tinchero G, Citerio G, et al : Fever management in SAH. Neurocrit Care 15: 287-294, 2011 7) Fernandez A, Schmidt JM, Claassen J, et al : Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology 68: 1013-1019, 2007 6) Diringer MN, Neurocritical Care Fever Reduction Trial Group : Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 32: 559-564, 2004 9) Jimbo H, Dohi K, Nakamura Y, et al : Fatal severe vasospasm due to rewarming following hypothermia—case report. Neurol Med Chir (Tokyo)40: 463-466, 2000 22) Seule MA, Muroi C, Mink S, et al : Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery 64: 86-92, 2009 2) Badjatia N, Fernandez L, Schmidt JM, et al : Impact of induced normothermia on outcome after subarachnoid hemorrhage: a case-control study. Neurosurgery 66: 696-700, 2010 21) Seule M, Muroi C, Sikorski C, et al : Therapeutic hypothermia reduces middle cerebral artery velocity in patients with severe aneurysmal subarachnoid hemorrhage. Neurocrit Care 20: 255-262, 2014 4) Broessner G, Beer R, Lackner P, et al : Prophylactic, endovascularly based, long-term normothermia in ICU patients with severe cerebrovascular disease: bicenter prospective, randomized trial. Stroke 40: e657-665, 2009 12) Kobata H, Nishihara I, Fukumoto H, et al : Ultra-Early Induction of Brain Hypothermia for Patients with Poor-Grade Subarachnoid Hemorrhage. Hayashi N, Bullock R, Dietrich DW, et al (eds) : Hypothermia for Acute Brain Damage: Pathomechanism and Practical Aspects. Tokyo, SpringerVerlag, 2004, pp215-219 17) Oliveira-Filho J, Ezzeddine MA, Segal AZ, et al : Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 56: 1299-1304, 2001 5) Broessner G, Lackner P, Fischer M, et al : Influence of prophylactic, endovascularly based normothermia on inflammation in patients with severe cerebrovascular disease: a prospective, randomized trial. Stroke 41: 2969-2972, 2010 18) サーモガードシステム製品情報．旭化成ゾールメディカル〈https://www.ak-zoll.com/medical/thermo_guard 8) Hinz J, Rosmus M, Popov A, et al : Effectiveness of an intravascular cooling method compared with a conventional cooling technique in neurologic patients. J Neurosurg Anesthesiol 19: 130-135, 2007 23) Todd MM, Hindman BJ, Clarke WR, et al : Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage. Neurosurg 64: 897-908, 2009 1) Badjatia N, O'Donnell J, Baker JR, et al : Achieving normothermia in patients with febrile subarachnoid hemorrhage: feasibility and safety of a novel intravascular cooling catheter. Neurocrit Care 1: 145-156, 2004 10) Keller E, Imhof HG, Gasser S, et al : Endovascular cooling with heat exchange catheters: a new method to induce and maintain hypothermia. Intensive Care Med 29: 939-943, 2003 15) Naidech AM, Bendok BR, Bernstein RA, et al : Fever burden and functional recovery after subarachnoid hemorrhage. Neurosurgery 63: 212-217, 2008 |
| References_xml | – reference: 8) Hinz J, Rosmus M, Popov A, et al : Effectiveness of an intravascular cooling method compared with a conventional cooling technique in neurologic patients. J Neurosurg Anesthesiol 19: 130-135, 2007 – reference: 23) Todd MM, Hindman BJ, Clarke WR, et al : Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage. Neurosurg 64: 897-908, 2009 – reference: 2) Badjatia N, Fernandez L, Schmidt JM, et al : Impact of induced normothermia on outcome after subarachnoid hemorrhage: a case-control study. Neurosurgery 66: 696-700, 2010 – reference: 14) Müller A, Lorenz A, Seifert B, et al : Risk of thromboembolic events with endovascular cooling catheters in patients with subarachnoid hemorrhage. Neurocrit Care 21: 207-210, 2014 – reference: 3) Badjatia N, Strongilis E, Gordon E, et al : Metabolic impact of shivering during therapeutic temperature modulation. The bedside shivering assessment scale. Stroke 39: 3242-3247, 2008 – reference: 19) Scaravilli V, Tinchero G, Citerio G, et al : Fever management in SAH. Neurocrit Care 15: 287-294, 2011 – reference: 21) Seule M, Muroi C, Sikorski C, et al : Therapeutic hypothermia reduces middle cerebral artery velocity in patients with severe aneurysmal subarachnoid hemorrhage. Neurocrit Care 20: 255-262, 2014 – reference: 10) Keller E, Imhof HG, Gasser S, et al : Endovascular cooling with heat exchange catheters: a new method to induce and maintain hypothermia. Intensive Care Med 29: 939-943, 2003 – reference: 12) Kobata H, Nishihara I, Fukumoto H, et al : Ultra-Early Induction of Brain Hypothermia for Patients with Poor-Grade Subarachnoid Hemorrhage. Hayashi N, Bullock R, Dietrich DW, et al (eds) : Hypothermia for Acute Brain Damage: Pathomechanism and Practical Aspects. Tokyo, SpringerVerlag, 2004, pp215-219 – reference: 22) Seule MA, Muroi C, Mink S, et al : Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery 64: 86-92, 2009 – reference: 7) Fernandez A, Schmidt JM, Claassen J, et al : Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology 68: 1013-1019, 2007 – reference: 5) Broessner G, Lackner P, Fischer M, et al : Influence of prophylactic, endovascularly based normothermia on inflammation in patients with severe cerebrovascular disease: a prospective, randomized trial. Stroke 41: 2969-2972, 2010 – reference: 6) Diringer MN, Neurocritical Care Fever Reduction Trial Group : Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 32: 559-564, 2004 – reference: 15) Naidech AM, Bendok BR, Bernstein RA, et al : Fever burden and functional recovery after subarachnoid hemorrhage. Neurosurgery 63: 212-217, 2008 – reference: 13) Kuramatsu JB, Kollmar R, Gerner ST, et al : Is hypothermia helpful in severe subarachnoid hemorrhage? An exploratory study on macrovascurar spasm, delayed cerebral infarction and functional outcome after prolonged hypothermia. Cerebrovasc Dis 40: 228-235, 2015 – reference: 16) Oddo M, Frangos S, Milby A, et al : Induced normothermia attenuates cerebral metabolic distress in patients with aneurysmal subarachnoid hemorrhage and refractory fever. Stroke 40: 1913-1916, 2009 – reference: 20) Schmutzhard E, Engelhardt K, Beer R, et al : Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 30: 2481-2488, 2002 – reference: 9) Jimbo H, Dohi K, Nakamura Y, et al : Fatal severe vasospasm due to rewarming following hypothermia—case report. Neurol Med Chir (Tokyo)40: 463-466, 2000 – reference: 17) Oliveira-Filho J, Ezzeddine MA, Segal AZ, et al : Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. Neurology 56: 1299-1304, 2001 – reference: 1) Badjatia N, O'Donnell J, Baker JR, et al : Achieving normothermia in patients with febrile subarachnoid hemorrhage: feasibility and safety of a novel intravascular cooling catheter. Neurocrit Care 1: 145-156, 2004 – reference: 11) 小畑仁司，田中英夫，多田裕一，ほか：最重症くも膜下出血に対する可及的早期脳低温療法は有用か．日救急医会誌 12:669-679, 2001 – reference: 4) Broessner G, Beer R, Lackner P, et al : Prophylactic, endovascularly based, long-term normothermia in ICU patients with severe cerebrovascular disease: bicenter prospective, randomized trial. Stroke 40: e657-665, 2009 – reference: 18) サーモガードシステム製品情報．旭化成ゾールメディカル〈https://www.ak-zoll.com/medical/thermo_guard/〉 |
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| SubjectTerms | complication delayed cerebral ischemia endovascular cooling subarachnoid hemorrhage temperature management |
| Title | 重症くも膜下出血患者に対する血管内冷却カテーテルによる体温管理の可能性と安全性について ─低体温療法から復温後の常温管理に関する初期経験 |
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