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'Cool and quiet' therapy for malignant hyperthermia following severe traumatic brain injury: A preliminary clinical approach

机译：颅脑外伤后恶性高热的“冷静，安静”疗法：一种初步的临床方法

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摘要

Malignant hyperthermia increases mortality and disability in patients with brain trauma. A clinical treatment for malignant hyperthermia following severe traumatic brain injury, termed 'cool and quiet' therapy by the authors of the current study, was investigated. Between June 2003 and June 2013, 110 consecutive patients with malignant hyperthermia following severe traumatic brain injury were treated using mild hypothermia (35-36 degrees C) associated with small doses of sedative and muscle relaxant. Physiological parameters and intracranial pressure were monitored, and the patients slowly rewarmed following the maintenance of mild hypothermia for 3-12 days. Consecutive patients who had undergone normothermia therapy were retrospectively analyzed as the control. In the mild hypothermia group, the recovery rate was 54.5%, the mortality rate was 22.7%, and the severe and mild disability rates were 11.8 and 10.9%, respectively. The mortality rate of the patients, particularly that of patients with a Glasgow Coma Scale (GCS) score of between 3 and 5 differed significantly between the hypothermia group and the normothermia group (P<0.05). The mortality of patients with a GCS score of between 6 and 8 was not significantly different between the two groups (P>0.05). The therapy using mild hypothermia with a combination of sedative and muscle relaxant was beneficial in decreasing the mortality of patients with malignant hyperthermia following severe traumatic brain injury, particularly in patients with a GCS score within the range 3-5 on admission. The therapy was found to be safe, effective and convenient. However, rigorous clinical trials are required to provide evidence of the effectiveness of 'cool and quiet' therapy for hyperthermia.
机译：恶性高热会增加脑外伤患者的死亡率和致残率。研究了严重脑外伤后恶性高热的临床治疗方法，该方法被本研究的作者称为“冷静和安静”疗法。在2003年6月至2013年6月之间，连续110例严重脑外伤后恶性体温过高的患者接受了轻度体温过低（35-36摄氏度）以及小剂量的镇静剂和肌肉松弛剂的治疗。监测生理参数和颅内压，并在维持轻度体温过低3-12天后，使患者缓慢恢复体温。回顾性分析接受过常温疗法的连续患者作为对照。亚低温治疗组的恢复率为54.5％，死亡率为22.7％，重度和轻度残疾率分别为11.8％和10.9％。在低温治疗组和正常体温治疗组之间，患者的死亡率，特别是格拉斯哥昏迷量表（GCS）评分在3至5之间的患者，死亡率差异显着（P <0.05）。 GCS评分在6至8之间的患者的死亡率在两组之间没有显着差异（P> 0.05）。结合镇静剂和肌肉松弛剂使用轻度低温疗法的治疗有利于降低严重颅脑损伤后恶性体温过高患者的死亡率，尤其是入院时GCS评分在3-5范围内的患者。发现该疗法是安全，有效和方便的。但是，需要进行严格的临床试验，以提供“冷静，安静”疗法对热疗的有效性的证据。

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