Keep the Brain Cool-Endovascular Cooling in Patients With Severe Traumatic Brain Injury: A Case Series Study
Keep the Brain Cool-Endovascular Cooling in Patients With Severe Traumatic Brain Injury: A Case Series Study
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DOI：
10.1227/neu.0b013e318208f5fb
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发表时间：
2011-04-01
期刊：
影响因子：
4.8
通讯作者：
Broessner, Gregor
中科院分区：
文献类型：
--
作者：
Fischer, Marlene;Lackner, Peter;Broessner, Gregor
背景：据报道，创伤性脑损伤（TBI）患者的脑温度普遍高于核心体温，因此创伤后热疗在损伤的大脑中具有特殊的相关性。目的：研究预防性降温对血管内降温治疗重型颅脑损伤患者脑温度及脑与核心体间温度梯度的影响，探讨血管内降温条件下脑温度与颅内压（ICP）的关系。方法：前瞻性病例系列研究在三级护理大学医院神经重症监护室进行。7例格拉斯哥昏迷评分为8分或更低的严重TBI患者连续入组。预防性恒温，定义为目标温度为36.5摄氏度，使用血管内冷却系统维持。在72小时内同时测量脑和膀胱温度和ICP。结果：常温患者膀胱平均温度为36.3 +/- 0.4℃，测定脑平均温度为36.4 +/- 0.5℃，脑和膀胱平均温差为0.1℃，发现脑和膀胱温度有显著的直接相关性（r = 0.95）。在52.4%的测量中，脑温度高于核心体温。结论：血管内温度管理能稳定脑和体核心温度；预防性降温可降低严重TBI患者脑内温度的极端升高。血管内降温处理是控制脑温、避免脑热伤的有效可行方法。我们没有发现脑温度和颅内压之间有统计学意义的相关性。
BACKGROUND: As brain temperature is reported to be extensively higher than core body temperature in traumatic brain injury (TBI) patients, posttraumatic hyperthermia is of particular relevance in the injured brain.OBJECTIVE: To study the influence of prophylactic normothermia on brain temperature and the temperature gradient between brain and core body in patients with severe TBI using an intravascular cooling system and to assess the relationship between brain temperature and intracranial pressure (ICP) under endovascular temperature control.METHODS: Prospective case series study conducted in the neurologic intensive care unit of a tertiary care university hospital. Seven patients with severe TBI with a Glasgow Coma Scale score of 8 or less were consecutively enrolled. Prophylactic normothermia, defined as a target temperature of 36.5 degrees C, was maintained using an intravascular cooling system. Simultaneous measurements of brain and urinary bladder temperature and ICP were taken over a 72-hour period.RESULTS: The mean bladder temperature in normothermic patients was 36.3 +/- 0.4 degrees C, and the mean brain temperature was determined as 36.4 +/- 0.5 degrees C. The mean temperature difference between brain and bladder was 0.1 degrees C. We found a significant direct correlation between brain and bladder temperature (r = 0.95). In 52.4% of all measurements, brain temperature was higher than core body temperature. The mean ICP was 18 +/- 8 mm Hg.CONCLUSION: Intravascular temperature management stabilizes both brain and body core temperature; prophylactic normothermia reduces the otherwise extreme increase of intracerebral temperature in patients with severe TBI. The intravascular cooling management proved to be an efficacious and feasible method to control brain temperature and to avoid hyperthermia in the injured brain. We could not find a statistically significant correlation between brain temperature and ICP.