Takagi Kiyoshi, Tsuchiya Yoshiaki, Okinaga Kimiko, Hirata Masafumi, Nakagomi Tadayoshi, Tamura Akira
Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.
J Neurosurg. 2003 Jan;98(1):50-6. doi: 10.3171/jns.2003.98.1.0050.
Spontaneous subarachnoid hemorrhage (SAH) has an aspect of graded transient global cerebral ischemia. The purpose of the present study was the documentation of sequential changes in body temperature immediately after SAH-induced transient global cerebral ischemia in humans.
Patients admitted within 12 hours after the initial onset of SAH were examined retrospectively (426 patients). Patients with unruptured cerebral aneurysms served as a control group (73 patients). Body temperature measured at the axilla on admission was analyzed. The grade of SAH was established according to the Glasgow Coma Scale (GCS): Grade I, GCS Score 15; Grade II, GCS Score 11 to 14; Grade III, GCS Score 8 to 10; Grade IV, GCS Score 4 to 7; and Grade V, GCS Score 3. The mean body temperature of patients in the control group was 36.49 +/- 0.45 degrees C (mean +/- standard deviation). The mean body temperature of patients in the SAH group who had been admitted within 4 hours of onset for Grades I to V were significantly different (p < 0.001, analysis of variance [ANOVA]): 36.26 +/- 0.7 degrees C, 59 patients; 35.98 +/-0.85 degrees C, 73 patients; 35.52 +/- 0.79 degrees C, 25 patients; 35.9 +/- 1.09 degrees C, 108 patients; and 35.56 +/- 1.14 degrees C, 73 patients, respectively. These values were significantly lower than those in control volunteers, except for patients with Grade I SAH. The reduction in body temperature was unrelated to the location of the cerebral aneurysm and was not the product of circadian rhythm. The temperatures of patients in the SAH group who were admitted beyond 4 hours after onset for each grade were significantly different (p < 0.01, ANOVA): 36.8 +/- 0.91 degrees C, 36 patients; 36.74 +/- 0.68 degrees C, 31 patients; 36.73 +/- 0.38 degrees C, three patients; 37.41 +/- 1.37 degrees C, 17 patients; and 38.9 degrees C, one patient, respectively. These values were significantly higher than those in patients admitted within 4 hours of SAH onset for all grades except Grade V, and significantly higher than control values in patients with Grades I and IV SAH.
These results indicate that body temperature falls and then rises immediately after the SAH-induced transient global cerebral ischemia without cardiac arrest in humans. The reduction in temperature may be a natural cerebral protection mechanism that is activated shortly after ischemic insult.
自发性蛛网膜下腔出血（SAH）具有分级短暂性全脑缺血的特征。本研究的目的是记录SAH诱导的人类短暂性全脑缺血后体温的连续变化。
对SAH首发后12小时内入院的患者进行回顾性研究（426例患者）。未破裂脑动脉瘤患者作为对照组（73例患者）。分析入院时腋窝测量的体温。根据格拉斯哥昏迷量表（GCS）确定SAH分级：I级，GCS评分为15分；II级，GCS评分为11至14分；III级，GCS评分为8至10分；IV级，GCS评分为4至7分；V级，GCS评分为3分。对照组患者的平均体温为36.49±0.45℃（平均值±标准差）。SAH组I至V级患者在发病后4小时内入院的平均体温有显著差异（p<0.001，方差分析[ANOVA]）：分别为36.26±0.7℃，59例患者；35.98±0.85℃，73例患者；35.52±0.79℃，25例患者；35.9±1.09℃，108例患者；35.56±1.14℃，73例患者。除I级SAH患者外，这些值均显著低于对照志愿者的值。体温降低与脑动脉瘤的位置无关且不是昼夜节律的产物。SAH组各分级患者在发病后4小时以上入院时体温有显著差异（p<0.01, ANOVA）：分别为36.8±0.91℃, 36例患者；36.74±0.68℃, 31例患者；36.73±0.38℃, 3例患者；37.41±1.37℃, 17例患者；38.9℃, 1例患者。除V级外，所有分级的这些值均显著高于SAH发病后4小时内入院患者的值，且I级和IV级SAH患者的值显著高于对照值。
这些结果表明，在人类SAH诱导的无心脏骤停的短暂性全脑缺血后，体温先下降然后立即上升。体温降低可能是缺血性损伤后不久激活的一种自然脑保护机制。
