Severe traumatic head injury in adults: Which patients are at risk of early hyperthermia?
Severe traumatic head injury in adults: Which patients are at risk of early hyperthermia?
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DOI：
10.1007/s00134-004-2280-y
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发表时间：
2004-05-01
影响因子：
38.9
通讯作者：
Marty, J
中科院分区：
文献类型：
--
作者：
Geffroy, A;Bronchard, R;Marty, J
目标。预防继发性损伤，如热疗，是创伤性脑损伤后的主要目标。我们研究的目的是确定严重头部损伤患者早期热疗的危险因素。设计。回顾性队列研究。设置。700张床位的教学医院，17张床位的多学科ICU。病人。在1999年1月至2001年12月期间，共有101名需要根据国际指南持续监测颅内压的成年患者入院。测量和结果。44例患者出现早期高热（前2天内至少出现一次体温低于38.5℃）。在单因素分析中，五个变量与早期热疗相关：性别；体温;入院时白细胞计数；预防性使用对乙酰氨基酚；2天内尿崩症。多因素分析显示，入院时白细胞计数>14.5x10(9)/l（优势比为7.1,95%可信区间为2.4-20.5,p=0.001）和入院时体温>36度（优势比为6.7,95%可信区间为2.3-20.1）是早期高热的重要危险因素。预防性使用对乙酰氨基酚与早期热疗呈负相关（优势比为0.1；95%可信区间为0.02-0.4）。早期热疗患者恢复良好的可能性较小（GOS=5; p=0.03）。重度或中度残疾患者（GOS=3或4）早期热疗较多（p=0.01）。结论。我们确定了一个亚组患者早期高热的高风险，这在严重头部损伤患者中很常见。这些结果可能对成人创伤性脑损伤后热疗的预防具有临床意义。
Objective. Prevention of secondary insults, such as hyperthermia, is a major goal after traumatic brain injury. The aim of our study was to identify risk factors for early hyperthermia in severe head-injured patients. Design. Retrospective cohort study. Setting. A 17-bed multidisciplinary ICU of a 700-bed teaching hospital. Patients. A total of 101 adult patients admitted from January 1999 to December 2001 requiring continuous monitoring of intracranial pressure according to international guidelines. Measurement and results. Forty-four patients experienced early hyperthermia (at least one episode of body temperature >38.5degreesC within the first 2 days). On univariate analysis five variables were associated with early hyperthermia: sex; body temperature; white blood cell count on admission; prophylactic use of acetaminophen; and diabetes insipidus within 2 days. On multivariate analysis, white blood cell count >14.5x10(9)/l on admission (odds ratio, 7.1; 95% confidence interval, 2.4-20.5; p=0.001) and a body temperature on admission >36degreesC (odds ratio, 6.7; 95% confidence interval, 2.3-20.1) were strong risk factors of early hyperthermia. Prophylactic use of acetaminophen was negatively associated with early hyperthermia (odds ratio, 0.1; 95% confidence interval, 0.02-0.4). Patients who experienced early hyperthermia were less prone to have good recovery (GOS=5; p=0.03). More patients with severe or moderate disability (GOS=3 or 4) experienced early hyperthermia (p=0.01). Conclusion. We identified a subgroup of patients at high risk of early hyperthermia, which is common in severe head-injured patients. These results could have clinical implications for prevention of hyperthermia after traumatic brain injury in adults.