Rosengart Axel J, Zhu Liang, Schappeler Thomase, Goldenberg Fernando D
Department of Neurology and Neurosurgery, F-610, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
J Clin Neurosci. 2009 Jan;16(1):51-5. doi: 10.1016/j.jocn.2008.04.003.
Fever is an independent predictor of worse outcome in stroke patients. We hypothesized that a peripheral infusion of saline in chilled or ice slurry form can be a practical adjuvant therapy to maintain euthermia. We developed a theoretical model simulating systemic body cooling in response to 0 degrees C saline and 50% ice slurry. Temperature elevations up to 39 degrees C were studied with respect to the time needed to reach a core temperature of 37 degrees C. Mathematical modeling identified a cooling rate of 0.48 degrees C/hr and 0.24 degrees C/hr using a 450 mL/hr infusion of 50% ice slurry and chilled saline. A reduction of the infusion rate to 150 mL/hr decreased euthermia time by a factor of 3; however, the total amount of coolant remained constant. Thus, based on mathematical modeling, peripheral infusions of saline in chilled or ice slurry form can be used as an adjunct therapy to achieve euthermia and control fever. Using intravenous coolants in an on-demand, temperature-guided and supervised treatment setting seems most reasonable to avoid potentially unsafe use of extended fluid volumes and infusion times.
发热是卒中患者预后较差的独立预测因素。我们假设，以冷冻或冰浆形式外周输注生理盐水可作为维持正常体温的一种实用辅助治疗方法。我们建立了一个理论模型，模拟0℃生理盐水和50%冰浆引起的全身降温。针对达到37℃核心体温所需时间，研究了高达39℃的体温升高情况。数学建模确定，使用450 mL/hr输注50%冰浆和冷冻生理盐水时，降温速率分别为0.48℃/小时和0.24℃/小时。将输注速率降至150 mL/hr会使正常体温维持时间缩短至原来的三分之一；然而，冷却剂总量保持不变。因此，基于数学建模，以冷冻或冰浆形式外周输注生理盐水可作为辅助治疗方法来实现正常体温并控制发热。在按需、温度引导和监督的治疗环境中使用静脉冷却剂似乎最为合理，以避免潜在不安全地使用大量液体和延长输注时间。
