Kasner Scott E, Wein Theodore, Piriyawat Paisith, Villar-Cordova Carlos E, Chalela Julio A, Krieger Derk W, Morgenstern Lewis B, Kimmel Stephen E, Grotta James C
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Stroke. 2002 Jan;33(1):130-4. doi: 10.1161/hs0102.101477.
Mild alterations in temperature have prominent effects on ischemic cell injury and stroke outcome. Elevated core body temperature (CBT), even if mild, may exacerbate neuronal injury and worsen outcome, whereas hypothermia is potentially neuroprotective. The antipyretic effects of acetaminophen were hypothesized to reduce CBT.
This was a randomized, controlled clinical trial at 2 university hospitals. Patients were included if they had stroke within 24 hours of onset of symptoms, National Institutes of Health Stroke Scale (NIHSS) score > or =5, initial CBT <3 8.5 degrees C, and white blood cell count < 12 600 cells/mm(3); they were excluded if they had signs of infection, severe medical illness, or contraindication to acetaminophen. CBT was measured every 30 minutes. Patients were randomized to receive acetaminophen 650 mg or placebo every 4 hours for 24 hours. The primary outcome measure was mean CBT during the 24-hour study period; the secondary outcome measure was the change in NIHSS.
Thirty-nine patients were randomized. Baseline CBT was the same: 36.96 degrees C for acetaminophen versus 36.95 degrees C for placebo (P=0.96). During the study period, CBT tended to be lower in the acetaminophen group (37.13 degrees C versus 37.35 degrees C), a difference of 0.22 degrees C (95% CI, -0.08 degrees C to 0.51 degrees C; P=0.14). Patients given acetaminophen tended to be more often hypothermic <36.5 degrees C (OR, 3.4; 95% CI, 0.83 to 14.2; P=0.09) and less often hyperthermic >37.5 degrees C (OR, 0.52; 95% CI, 0.19 to 1.44; P=0.22). The change in NIHSS scores from baseline to 48 hours did not differ between the groups (P=0.93).
Early administration of acetaminophen (3900 mg/d) to afebrile patients with acute stroke may result in a small reduction in CBT. Acetaminophen may also modestly promote hypothermia <36.5 degrees C or prevent hyperthermia >37.5 degrees C. These effects are unlikely to have robust clinical impact, and alternative or additional methods are needed to achieve effective thermoregulation in stroke patients.
体温的轻微变化对缺血性细胞损伤和卒中结局有显著影响。即使是轻度的核心体温（CBT）升高，也可能加重神经元损伤并使结局恶化，而低温则具有潜在的神经保护作用。据推测，对乙酰氨基酚的解热作用可降低CBT。
这是一项在2所大学医院进行的随机对照临床试验。纳入症状发作24小时内发生卒中、美国国立卫生研究院卒中量表（NIHSS）评分≥5分、初始CBT<38.5℃且白细胞计数<12600个/mm³的患者；排除有感染迹象、严重内科疾病或对乙酰氨基酚有禁忌证的患者。每30分钟测量一次CBT。患者被随机分为每4小时接受650mg对乙酰氨基酚或安慰剂治疗，共24小时。主要结局指标是24小时研究期间的平均CBT；次要结局指标是NIHSS的变化。
39例患者被随机分组。基线CBT相同：对乙酰氨基酚组为36.96℃，安慰剂组为36.95℃（P=0.96）。在研究期间，对乙酰氨基酚组的CBT倾向于较低（37.13℃对37.35℃），相差0.22℃（95%CI，-0.08℃至0.51℃；P=0.14）。服用对乙酰氨基酚的患者体温<36.5℃的情况更常见（比值比[OR]，3.4；95%CI，0.83至14.2；P=0.09），体温>37.5℃的情况较少见（OR，0.52；95%CI，0.19至1.44；P=0.22）。两组从基线到48小时的NIHSS评分变化无差异（P=0.93）。
对急性卒中无发热的患者早期给予对乙酰氨基酚（3900mg/d）可能会使CBT略有降低。对乙酰氨基酚也可能适度促进体温<36.5℃或预防体温>37.5℃。这些作用不太可能产生强大临床影响，需要采用其他方法或额外方法来实现卒中患者有效的体温调节。
