Stocchetti Nino, Rossi Sandra, Zanier Elisa Roncati, Colombo Angelo, Beretta Luigi, Citerio Giuseppe
Terapia Intensiva Neuroscienze, Ospedale Maggiore, Policlinico IRCCS, Via S Sforza, 3520 122 Milan, Italy.
Intensive Care Med. 2002 Nov;28(11):1555-62. doi: 10.1007/s00134-002-1513-1. Epub 2002 Oct 4.
(a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP.
Multicenter retrospective observational study in three ICUs in the Milan area.
110 patients with traumatic brain injury.
Eighty patients suffered pyrexia, defined as an external temperature higher than 38 degrees C or internal temperature higher than 38.4 degrees C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58+/-0.7 degrees C) but caused a significant drop in CPP (6.5+/-12.5 mmHg).
Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.
(a) 量化头部受伤后第一周内发热的发生率；(b) 阐明发热与神经功能严重程度、在重症监护病房（ICU）的住院时间、颅内高压和脑灌注压（CPP）之间的关系；(c) 描述退热治疗对体温、颅内压（ICP）和 CPP 的影响。
在米兰地区的三个重症监护病房进行的多中心回顾性观察研究。
110 例创伤性脑损伤患者。
80 例患者出现发热，定义为体表温度高于 38 摄氏度或体内温度高于 38.4 摄氏度。发热的发生率和持续时间与神经功能损害程度及在 ICU 的住院时间延长有关。在中脑周围脑池正常的患者中，发热病例的颅内压升高发作更为频繁。66 例患者使用了各种退热治疗方法。药物治疗效果稍差（平均体温降低 0.58±0.7 摄氏度），但导致 CPP 显著下降（6.5±12.5 mmHg）。
发热在头部受伤后的急性期极为常见。在病情较重的病例中发生率更高，且与在 ICU 的住院时间延长相关。它可能影响颅内压，但当存在其他导致颅内容积增加的主要原因时，其作用难以评估。退热治疗在控制体温方面效果不佳，且可能对 CPP 有害。
