Cairns Chris J S, Andrews Peter J D
Specialist Registrar in Intensive Care Medicine and Reader in Anesthetics, Intensive Care, and Pain Medicine, Western General Hospital, University of Edinburgh, Edinburgh, Scotland, UK.
Curr Opin Crit Care. 2002 Apr;8(2):106-10. doi: 10.1097/00075198-200204000-00003.
Recently there has been much interest in the use of hypothermia in the management of the brain-injured patient and its effect on outcome. Most of these studies examine the use of hypothermia compared with normothermia of 37 degrees C and have failed to demonstrate a benefit in the treatment groups, but what is normothermia in the brain-injured patient? Good epidemiologic evidence suggests that the vast majority of patients admitted to an ICU environment will develop a fever. The development of fever is clearly associated with a worse prognosis. There is now a better understanding of the possible mechanism of harm of fever and the side effects of cooling. Several treatment options for controlling temperature are discussed. Despite a sound physiologic argument for controlling fever in the brain-injured patient, there is no evidence that doing so will improve outcome.
最近，低温疗法在脑损伤患者管理中的应用及其对预后的影响备受关注。这些研究大多将低温疗法与37摄氏度的正常体温进行比较，且未能在治疗组中证明其益处，但脑损伤患者的正常体温是多少呢？充分的流行病学证据表明，绝大多数入住重症监护病房的患者会发烧。发烧的出现显然与更差的预后相关。目前，人们对发烧可能的危害机制以及降温的副作用有了更好的理解。文中讨论了几种控制体温的治疗选择。尽管有合理的生理学依据支持对脑损伤患者进行发热控制，但尚无证据表明这样做会改善预后。
