The effect of body temperature in the acute phase of subarachnoid hemorrhage on the long term outcome

背景：近年来，实验和临床研究表明，脑温是决定脑部疾病预后的最重要因素之一。本研究的目的是评价蛛网膜下腔出血急性期体温控制的效果。材料和方法：首先，我们根据格拉斯哥昏迷评分和格拉斯哥预后评分的标准结果(死亡=1到恢复良好=5)，制定了新的蛛网膜下腔出血分级标准。我们调查了SAH评分与入院时体温的关系。8例蛛网膜下腔出血患者在病情急性期用降温毯进行温控治疗，使其处于轻度低温状态。结果：新制定的SAH分级为：I级(GCS=15)，II级(GCS=11~14)，III级(GCS=8~10)，IV级(GCS=4~7)，V级(GCS=3)。每个SAH分级的标准结果分别如下：4.68(SY+-)。[)0.05，4.10(]sy.+-.[)0.06，3.55(]SY+-.[)0.11，2.65(正态+-)。[)0.10和1.81(正态+-)。[)0.22。体温控制组患者的预后未超过标准预后。SAH分级低的患者体温明显低于SAH分级高的患者。结论：SAH患者的亚低温治疗应慎重，以达到超标治疗的目的。

Background : In recent years, it has been disclosed experimentally and clinically that the brain temperature is one of the most important factors that decide the outcome of the brain disease. The purpose of this study is to evaluate the effect of the body temperature control in the acute phase of the subarachnoid hemorrage.Materials and Method : First, we developed a new SAH grading scale based solely upon the Glasgow Coma Scale and the standard outcome evaluated by Glasgow Outcome Scale with numerical translation (dead=1 to good recovery=5) for each grade. We investigated the relatioship between the SAH grade and the body temperature on the admission. Eight patients with SAH received temperature control therapy in the acute phase of the disease uwing cooling blanket to be kept at slightly hypothermic condition. The outcome was evaluated at 3 months after the onset.Results : A newly developed SAH grading is as follows ; I (GCS=15), II (GCS=11-14), III (GCS=8-10), IV (GCS=4-7), and V (GCS=3). Standard outcomes for each SAH grade are as follows respectively ; 4.68(]SY.+-。[)0.05,4.10(]SY.+-。[)0.06,3.55(]SY.+-。[)0.11,2.65(]SY.+-。[)0.10, and 1.81(]SY.+-。[)0.22. The outcome of the patients with temperature control did not exceed the standard outcome. The body temperature in the patients with low SAH grade was significantly lower than those with high SAH grade.Conclusion : These results suggest that the application of the hypothermia therapy to the patients with SAH must be done with great care in order to exceed the standard outcome.