Abstract
Systemic therapeutic hypothermia has gained a negative reputation in treating multiple trauma patients and is regarded as one of the factors in the lethal triad of shock, acidosis, and hypothermia. This fact owes to no relationship between acidosis and hypothermia; the effects of the latter on coagulation are evident and complexly reversible in the presence of acidosis. Objective: to determine the impact of noninvasive local brain cooling on the metabolic and blood coagulation indicators of a patient with acute cerebral ischemia. Subjects and methods. The subjects of the study were 113 patients with severe brain injury, including that complicated by the involvement of stem structures, who underwent brain cooling in different modifications. In so doing, the val ues of acidbase balance and coagulation system in arterial and venous blood were investigated. Results. Local brain hypother mia was not found to affect coagulation while the baseline negative values of excess buffer bases showed positive values (a right shift) by the end of cooling. Recommendations were given to prevent metabolic shifts. Conclusion. Patients at very high risk for bleeding may be safely cooled to a brain temperature of 32—34°C even in the presence of moderatetosevere acidosis. This is a great advantage of local hypothermia over systemic one.
Highlights
Об изменениях кислотно основного состояния (КОС) в условиях церебрального повреждения име ется мало данных
Patients were divided into the following groups in accor dance with a particular component of cooling: I) The control group patients underwent most suitable and commonly used non invasive methods of brain cooling (NIBC) (Fig. 1—3)
II) The studied group comprised of 71 patients with severe traumatic brain injury underwent nasopharyngeal cooling (NFC) in various modifications performed in accordance with the method developed by us1 (Fig. 4—7) in 80 cases and 100 sessions [19]
Summary
Об изменениях кислотно основного состояния (КОС) в условиях церебрального повреждения име ется мало данных. There are few data on changes of acid base balance (ABB) following a cerebral damage. The model of a two hour occlusion of the middle cerebral. Brain Injury клюзии средней мозговой артерии у крыс с последу ющей реперфузией и пятичасовой гипотермией (33°С) показала снижение объема церебрального ин фаркта и отека, увеличение мозгового кровотока [1]. Другое исследование свидетельствовало о выражен ной корреляции в снижении кровотока и напряжения углекислого газа (рСО2) в крови, но не с температу рой тела [2]. С одной стороны, торможение коагуляции может иметь положительные эффекты в виде улучшения ми кроциркуляции и подавления образования пагубных микротромбов в головном мозге [4]. С другой стороны, это может привести к увеличению риска кровотечения и, тем самым, причинить вред пациентам, особенно, ес ли они перенесли травму или активное кровотечение по другим причинам
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