亚低温治疗缺氧缺血性脑病PPT课件
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亚低温治疗缺氧缺血性脑病
1
目的 了解亚低温疗法的由来 明确亚低温治疗对缺血缺氧性脑病的 疗效 掌握我院亚低温疗法的方案
2
History of Therapeutic Hypothermia
• First scientific report was published in 1945 by Dr. Temple Fay
4
缺氧缺血性脑病HIE
围生期窒息引起的部分或完全缺氧、脑血 流减少或暂停导致的胎儿、新生儿脑损伤
我国HIE发病率3-6‰，其中15-20%在新生 儿期死亡。 存活者中20-30%有不同程度神经系统后遗 症
5
HIE in Neonates
• Diagnostic criteria are vague
– Latent (>6 hours)
• “Delayed neuronal death”
– Multiple mechanisms » Hyperemia 充血 » Cytotoxic edema 细胞毒性水肿 » Mitochondrial failure 线粒体·损伤 » Accumulation of excitotoxins 兴奋性氨基酸 » Active cell death » Nitric oxide synthesis NO失衡 » Free radical damage and cytotoxic actions of activated microglia
– Significant proportion of total injury
7
8
Figure 2. Patterns of brain injury in mild to moderate hypoperfusion
Chao, C. P. et al. Radiographics 2006;26:S159-S172
9
Copyright ©Radiological Society of North America, 2006
Pathophysiology of Brain Injury due to Hypoxic-Ischemic Insult
• Latent phase provides window of therapeutic intervention
– Low Apgar scores at 5 mins – Change in consciousness – Signs of significant hypoperfusion (ie acidosis) – Requirement for ventilation – Seizures – Other
• Recently this therapy has emerged as therapy for infants suffering HIE related to birth
14
Therapeutic Hypothermia in Babies
• Small human studies with encouraging results
10
Wagner, 2002 – Rats 11
Gunn, 1997 - Lambs 12
13
Tooley, 2003 – Piglets
Sumห้องสมุดไป่ตู้ary
• Multiple lines of evidence suggest therapeutic hypothermia may be neuroprotective
• 2 recent, randomized controlled trials of ~ 500 infants
– CoolCap – NICHD whole-body hypothermia
15
CoolCap
• Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial
– Gunn, 1998; 22 patients, head cooling – no adverse effects compared with control
– Azzopardi, 2000; 16 patients, whole body cooling – no adverse effects
6
Pathophysiology of Brain Injury due
to Hypoxic-Ischemic Insult
• 2 phases of neuronal death
– Immediate
• “Primary neuronal death”
– cellular hypoxia with exhaustion of the cell’s high energy stores (primary energy failure)
• Moderate or severe HIE ~ 0.5 – 1 per 1000 live births
• Mortality ~ 10 - 60% • Morbidity ~ 25% of survivors There are no specific treatments proven
to decrease brain damage from HIE
– Thoresen, 2000; 9 patients, both methods – non-hazardous cardiovascular changes noted, particularly with over-cooling or
– Shankaran, 2002; 19 patients, whole body cooling – no adverse effects
– “Observations on generalized refrigeration in cases of severe cerebral trauma”
– Also investigated use in cancer
3
HIE in Neonates
• Perinatal asphyxia ~ 3 – 5 per 1000 live births
1
目的 了解亚低温疗法的由来 明确亚低温治疗对缺血缺氧性脑病的 疗效 掌握我院亚低温疗法的方案
2
History of Therapeutic Hypothermia
• First scientific report was published in 1945 by Dr. Temple Fay
4
缺氧缺血性脑病HIE
围生期窒息引起的部分或完全缺氧、脑血 流减少或暂停导致的胎儿、新生儿脑损伤
我国HIE发病率3-6‰，其中15-20%在新生 儿期死亡。 存活者中20-30%有不同程度神经系统后遗 症
5
HIE in Neonates
• Diagnostic criteria are vague
– Latent (>6 hours)
• “Delayed neuronal death”
– Multiple mechanisms » Hyperemia 充血 » Cytotoxic edema 细胞毒性水肿 » Mitochondrial failure 线粒体·损伤 » Accumulation of excitotoxins 兴奋性氨基酸 » Active cell death » Nitric oxide synthesis NO失衡 » Free radical damage and cytotoxic actions of activated microglia
– Significant proportion of total injury
7
8
Figure 2. Patterns of brain injury in mild to moderate hypoperfusion
Chao, C. P. et al. Radiographics 2006;26:S159-S172
9
Copyright ©Radiological Society of North America, 2006
Pathophysiology of Brain Injury due to Hypoxic-Ischemic Insult
• Latent phase provides window of therapeutic intervention
– Low Apgar scores at 5 mins – Change in consciousness – Signs of significant hypoperfusion (ie acidosis) – Requirement for ventilation – Seizures – Other
• Recently this therapy has emerged as therapy for infants suffering HIE related to birth
14
Therapeutic Hypothermia in Babies
• Small human studies with encouraging results
10
Wagner, 2002 – Rats 11
Gunn, 1997 - Lambs 12
13
Tooley, 2003 – Piglets
Sumห้องสมุดไป่ตู้ary
• Multiple lines of evidence suggest therapeutic hypothermia may be neuroprotective
• 2 recent, randomized controlled trials of ~ 500 infants
– CoolCap – NICHD whole-body hypothermia
15
CoolCap
• Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial
– Gunn, 1998; 22 patients, head cooling – no adverse effects compared with control
– Azzopardi, 2000; 16 patients, whole body cooling – no adverse effects
6
Pathophysiology of Brain Injury due
to Hypoxic-Ischemic Insult
• 2 phases of neuronal death
– Immediate
• “Primary neuronal death”
– cellular hypoxia with exhaustion of the cell’s high energy stores (primary energy failure)
• Moderate or severe HIE ~ 0.5 – 1 per 1000 live births
• Mortality ~ 10 - 60% • Morbidity ~ 25% of survivors There are no specific treatments proven
to decrease brain damage from HIE
– Thoresen, 2000; 9 patients, both methods – non-hazardous cardiovascular changes noted, particularly with over-cooling or
– Shankaran, 2002; 19 patients, whole body cooling – no adverse effects
– “Observations on generalized refrigeration in cases of severe cerebral trauma”
– Also investigated use in cancer
3
HIE in Neonates
• Perinatal asphyxia ~ 3 – 5 per 1000 live births