目标体温管理在自发性脑出血治疗中的作用

The role of targeted temperature management in treatment of spontaneous intracerebral hemorrhage

摘要:

自发性脑出血（sICH）由于其高发病率和高病死率，在临床医学中仍然是一个巨大的挑战。其病理损伤机制包含原发性与继发性脑损伤的双重作用。由于良好的临床前神经保护结果，低温治疗一直备受关注，但临床试验尚未确定其最终有效性。正在进行的和即将进行的临床试验试图阐明目标体温管理在sICH中的影响。最新进展包括低温联合干细胞移植的协同治疗，以及目标体温管理的个体化应用探索。当前挑战集中于平衡低温的神经保护效应与并发症风险，这些并发症很有可能掩盖了疗效，研究人员正在追求优化的降温方案、糅合新技术整合多模态治疗策略及开展高质量临床试验，这对于释放低温的治疗潜力至关重要。该文旨在回顾近年来目标体温管理的相关研究，梳理这一治疗策略相关的基础分子机制、理念形成、临床进展及面临的任务和挑战，以期帮助人们加深理解和继续优化这一治疗策略。

Abstract:

Spontaneous intracerebral hemorrhage （sICH） remains a huge challenge in clinical medicine due to its high incidence and mortality rates. The pathogenic mechanism of sICH involves the dual influence of primary and secondary brain injuries. Although therapeutic hypothermia has attracted significant attention due to its promising neuroprotective effect in preclinical studies， its efficacy had not been confirmed in clinical trials. Ongoing and upcoming clinical trials aim to elaborate on the impact of targeted temperature management （TTM） in ICH， and recent advances have focused on synergistic therapies combining therapeutic hypothermia with stem cell transplantation and the exploration of individualized TTM regimens. Current challenges lie in how to balance the neuroprotective effect of therapeutic hypothermia against its risks of complications， which may conceal therapeutic benefits. Researchers are trying to optimize the strategies for reducing body temperature， integrate novel technologies for multimodal therapeutic approaches， and conduct high-quality clinical trials， and such efforts are important for unlocking the full therapeutic potential of therapeutic hypothermia. This article reviews the recent studies on TTM and systematically analyzes its basic molecular mechanisms， conceptual evolution， clinical advances， and existing challenges， in order to deepen the understanding and continuously optimize this therapeutic strategy.