Turaj Wojciech, Słowik Agnieszka, Szczudlik Andrzej
Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503 Kraków, Poland.
Neurol Neurochir Pol. 2008 Jul-Aug;42(4):316-22.
Hyperthermia worsens prognosis in ischaemic, but probably not in haemorrhagic stroke. The reason for this discrepancy is unknown; therefore we designed this study to compare factors related to the occurrence of hyperthermia in patients with ischaemic and haemorrhagic stroke.
We studied 100 consecutive patients with hemispheric intracerebral haemorrhage and 100 patients with hemispheric ischaemic stroke, who were strictly matched regarding sex (53% were men), age (mean: 67+/-10 years) and severity of neurological deficit on admission according to the Scandinavian Stroke Scale [median: 22 (8-34)]. Body temperature was measured on admission and every 4 hours within the first 48 hours after admission. We recorded neurological deficit, disorders of consciousness, major infectious complications, and a range of routine biochemical markers. Outcome was assessed by 30-day mortality and by the functional status of survivors 30 and 90 days after stroke.
The percentages of patients with hyperthermia (> 37.5 degrees C) were similar in ischaemic and haemorrhagic stroke (26% vs. 33% on day 1 and 19% vs. 23% on day 2, respectively). Patients with hyperthermia on day 1 in both groups had higher 30-day mortality, worse functional status after 90 days and more often had decreased consciousness on admission. Markers of inflammation were slightly higher in hyperthermic patients with ischaemic, but not with haemorrhagic stroke.
Hyperthermia in acute stroke, whether ischaemic or haemorrhagic, is associated with worse prognosis. Ischaemic stroke patients with hyperthermia have slightly increased levels of inflammatory markers when compared to patients without hyperthermia, but the same difference was not found in patients with haemorrhagic stroke.
体温过高会使缺血性卒中的预后恶化，但对出血性卒中可能并非如此。这种差异的原因尚不清楚；因此，我们设计了本研究，以比较缺血性和出血性卒中患者体温过高发生的相关因素。
我们研究了100例连续性半球脑出血患者和100例半球缺血性卒中患者，这些患者在性别（53%为男性）、年龄（平均：67±10岁）以及入院时根据斯堪的纳维亚卒中量表评估的神经功能缺损严重程度（中位数：22[8-34]）方面进行了严格匹配。入院时及入院后48小时内每4小时测量一次体温。我们记录了神经功能缺损、意识障碍、主要感染并发症以及一系列常规生化指标。通过30天死亡率以及卒中后30天和90天幸存者的功能状态来评估预后。
缺血性和出血性卒中患者体温过高（>37.5℃）的百分比相似（第1天分别为26%对33%，第2天分别为19%对23%）。两组第1天体温过高的患者30天死亡率更高，90天后功能状态更差，且入院时意识减退更为常见。缺血性卒中体温过高患者的炎症指标略高于无体温过高的患者，但出血性卒中患者未发现同样的差异。
急性卒中，无论是缺血性还是出血性，体温过高均与预后较差相关。与无体温过高的缺血性卒中患者相比，体温过高的缺血性卒中患者炎症指标水平略有升高，但出血性卒中患者未发现同样的差异。
