Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome.
Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome.
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DOI：
10.1186/1471-2377-12-123
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发表时间：
2012-10-18
期刊：
影响因子：
2.6
通讯作者：
Wardlaw JM
中科院分区：
文献类型：
--
作者：
Karaszewski B;Thomas RG;Dennis MS;Wardlaw JM
中风后发热(温度≥37.5C)与预后不良有关，但关于体温变化的时间以及与中风严重程度和亚型的关系的信息各不相同。我们招募了急性缺血性卒中患者，测量了卒中严重程度、卒中亚型，并记录了从入院到卒中后120小时的每四小时鼓室(体温)读数。我们寻找发热的原因，并在90天时测量功能结果。我们系统地总结了所有相关的前人研究。44例患者(男性21例，平均年龄72岁，年龄11岁)中，美国国立卫生研究院卒中评分(NIHSS)中位数为7(范围0-28)，14例为全前循环卒中(Tacs)。入院时，所有患者在卒中后4小时(四分位数范围，IQR，2-8)均为常温(中位数分别为36.3C和36.5C，P=0.382)，入院温度与NIHSS无关(R2=0.0P=0.353)。峰值体温出现在卒中后35.5h(IQR19.0~53.8h)，TACS组(37.7C)高于非TACS组(37.1°C，P=0.001)，且与NIHSS入院有关(R2=0.2，P=0.002)。90天的不良预后(改良的朗肯评分≥3)与较高的入院温度(36.6C比36.2C p=0.031)和最高温度(37.4C比37.0C，p=0.016)有关。16名患者(36%)出现发热，其中7名患者(44%)除中风外未发现其他原因。常温通常在中风后的前4小时内。峰值体温出现在卒中后1.5至2天，与卒中严重程度/亚型有关，与入院温度相比，与不良预后的关系更密切。卒中后体温与预后的关系是复杂的，但入院时体温较低不应排除患者随机参加治疗性低温试验。
Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0–28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2–8) after stroke; admission temperature and NIHSS were not associated (r2=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, p<0.001) and was associated with admission NIHSS (r2=0.20, p=0.002). Poor outcome (modified Rankin Scale ≥3) at 90 days was associated with higher admission (36.6°C vs. 36.2°C p=0.031) and peak (37.4°C vs. 37.0°C, p=0.016) temperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia.
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作者：
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