Mariak Z, Lysoń T, Piekarski P, Lewko J, Jadeszko M, Szydlik P
Kliniki Neurochirurgii Akademii Medycznej w Białymstoku.
Neurol Neurochir Pol. 2000 May-Jun;34(3):509-22.
The knowledge of human brain temperature is still very limited. In this report we investigated the relationship between brain and trunk temperature in neurosurgical patients during normothermia and fever. Another problem addressed was that of possible gradients of temperature within the brain. We carried out direct recordings of temperature in 63 operated, neurosurgical patients with a variety of intracranial pathologies. Flexible, teflon-coated thermocouples were placed intracranially during neurosurgical procedures. Oesophageal, rectal and tympanic temperatures were also monitored. An error of up to 1.3 degrees C is to be expected in single cases if brain temperature is deduced from the rectal or oesophageal temperature. Mean differences between brain temperature and core body temperature measured in the rectum or in the oesophagus, were between 0 to 0.3 degree C. Tympanic temperature (Tty) improved the approximation of brain temperature (Tbr) to within the mean difference between Tbr-Tty close to 0 degree C. Nevertheless Tty also differed from Tbr by as much as 1 degree C in single cases. Brain temperature was the highest body temperature measured, either in normothermia or in fever. Temperature gradients were proved to exist between the warmer brain interior and cooler surface, with maximal differences in temperature reaching 0.6 degree C. This temperature gradient tended to increase along with the rise in intracranial pressure and deterioration of the level of consciousness. Our results suggest that conclusions regarding brain temperature drawn on the basis of other core temperatures, may lead to significant errors, and intracranial temperature measurement is desirable in neurosurgical intensive care. Temperature gradients within the brain may exacerbate its biochemical injury during ischaemia and fever--a combination seen frequently in neurosurgical patients. This may be particularly so, since brain temperature in fever is the highest body temperature in a high proportion of these patients.
目前，我们对人类脑温的了解仍然非常有限。在本报告中，我们研究了神经外科患者在正常体温和发热状态下脑温与躯干温度之间的关系。另一个探讨的问题是脑内可能存在的温度梯度。我们对63例患有各种颅内病变的神经外科手术患者进行了温度直接记录。在神经外科手术过程中，将柔性的、涂有聚四氟乙烯的热电偶置于颅内。同时还监测了食管、直肠和鼓膜温度。如果根据直肠或食管温度推断脑温，个别情况下预计误差可达1.3摄氏度。脑温与直肠或食管测得的核心体温之间的平均差值在0至0.3摄氏度之间。鼓膜温度（Tty）使脑温（Tbr）的近似值更接近，Tbr - Tty之间的平均差值接近0摄氏度。然而，在个别情况下，Tty与Tbr的差异仍可达1摄氏度。无论是在正常体温还是发热状态下，脑温都是测得的最高体温。已证实较温暖的脑内部与较凉爽的脑表面之间存在温度梯度，温度最大差值达0.6摄氏度。这种温度梯度往往随着颅内压升高和意识水平恶化而增大。我们的结果表明，基于其他核心体温得出的关于脑温的结论可能会导致显著误差，在神经外科重症监护中进行颅内温度测量是可取的。脑内的温度梯度可能会在缺血和发热期间加剧其生化损伤，而这种情况在神经外科患者中经常出现。尤其在发热时，这些患者中很大一部分的脑温是最高体温，情况可能更是如此。
