The effect of decompressive hemicraniectomy on brain temperature after severe brain injury.
The effect of decompressive hemicraniectomy on brain temperature after severe brain injury.
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DOI：
10.1007/s12028-010-9446-y
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发表时间：
2011-08
影响因子：
3.5
通讯作者：
Hemphill, J. Claude, III
中科院分区：
文献类型：
--
作者：
Nakagawa, Kazuma;Hills, Nancy K.;Kamel, Hooman;Morabito, Diane;Patel, Pratik V.;Manley, Geoffrey T.;Hemphill, J. Claude, III
动物研究表明，即使是1摄氏度的小温度升高也会对脑损伤造成有害影响。由于颅骨作为一个潜在的隔热体，我们假设减压半颅骨切除术有助于表面冷却和降低大脑温度。回顾性研究48例重型颅脑损伤患者（TBI=38， ICH=10），连续监测脑温度，分为半脑切除术组（n=20）和未半脑切除术组（n=28）。在12±7天内，每隔1分钟测量一次核心体（TCore）和脑（TBr）温度。作为大脑表面热量损失程度的替代测量，ΔTCore-Br被计算为每次记录的TCore和TBr之间的差异。为了适应患者内部温度相关性，混合模型回归用于评估患有和未患有半骨切除术的患者在ΔTCore-Br上的差异，并根据核心体温和诊断进行调整。共收集了295,883对体温数据（每名患者的中位数[IQR]: 5047[3125-8457]）。两组患者的基线特征在年龄、性别、诊断、败血症发生率、格拉斯哥昏迷评分、ICU死亡率和ICU住院时间等方面相似。ΔTCore-Br的平均差值，切除半骨患者为1.29±0.87°C，未切除半骨患者为0.80±0.86°C （p<0.0001）。在混合模型回归中，考虑到患者体内温度的相关性，半脑切除术和更高的TCore与更高的ΔTCore-Br相关（半脑切除术：估计效果=0.60,p=0.003； TCore：估计效果=0.21,p<0.0001）。半颅骨切除术与相对于核心体温适度但显著降低的脑温度相关。
Animal studies have shown that even a small temperature elevation of one degree Celsius can cause detrimental effects after brain injury. Since the skull acts as a potential thermal insulator, we hypothesized that decompressive hemicraniectomy facilitates surface cooling and lowers brain temperature. Forty-eight patients with severe brain injury (TBI=38, ICH=10) with continuous brain temperature monitoring were retrospectively studied and grouped into “hemicraniectomy” (n=20) or “no hemicraniectomy” (n=28) group. The paired measurements of core body (TCore) and brain (TBr) temperature were recorded at 1-min intervals over 12±7 days. As a surrogate measure for the extent of surface heat loss from the brain, ΔTCore-Br was calculated as the difference between TCore and TBr with each recording. In order to accommodate within-patient temperature correlations, mixed-model regression was used to assess the differences in ΔTCore-Br between those with and without hemicraniectomy, adjusted for core body temperature and diagnosis. A total of 295,883 temperature data pairs were collected (median [IQR] per patient: 5047 [3125–8457]). Baseline characteristics were similar for age, sex, diagnosis, incidence of sepsis, Glasgow Coma Scale score, ICU mortality, and ICU length of stay between the two groups. The mean difference in ΔTCore-Br, was 1.29±0.87 °C for patients with and 0.80±0.86 °C for patients without hemicraniectomy (p<0.0001). In mixed-model regression, accounting for temperature correlations within patients, hemicraniectomy and higher TCore were associated with greater ΔTCore-Br (hemicraniectomy: estimated effect=0.60, p=0.003; TCore: estimated effect=0.21, p<0.0001). Hemicraniectomy is associated with modestly but significantly lower brain temperature relative to core body temperature.
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影响因子：
38.9
作者：
Geffroy, A;Bronchard, R;Marty, J
通讯作者：
Marty, J
影响因子：
4.8
作者：
Henker, RA;Brown, SD;Marion, DW
通讯作者：
Marion, DW
影响因子：
8.8
作者：
Rumana, CS;Gopinath, SP;Robertson, CS
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Robertson, CS
DOI：
10.1115/1.3138569
发表时间：
1985-01-01
影响因子：
1.7
作者：
OLSEN, RW;HAYES, LJ;EBERHART, RC
通讯作者：
EBERHART, RC
影响因子：
6.3
作者：
BUSTO, R;DIETRICH, WD;GINSBERG, MD
通讯作者：
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