APHP-Service de Réanimation Médicale, Groupe Hospitalier Mondor, Créteil, France.
Minerva Anestesiol. 2012 Nov;78(11):1254-64. Epub 2012 Jul 6.
Fever is a common symptom of sepsis usually believed to predict better survival. Experimental data suggest that body temperature elevation may slow micro-organism growth and enhance host immune responses. In patients with sepsis, however, the high energy cost of fever may exacerbate the life-threatening situation. Fever control is widely used in the ICU, mainly in patients with infections. The efficacy of antipyretic drugs in lowering body temperature remains uncertain, however, and all antipyretics have well known adverse effects. Surface cooling methods are efficient but require sedation to avoid the harmful effects of shivering. A recent controlled trial in patients with septic shock suggests that external cooling for fever control may diminish vasopressor requirements and improve early survival. In this review, we examine the benefits and risks of fever and of controlled normothermia. The fever control modalities that provide the best risk/benefit ratio in sepsis are discussed.
发热是脓毒症的常见症状，通常被认为可以预测更好的生存。实验数据表明，体温升高可能会减缓微生物的生长并增强宿主的免疫反应。然而，在脓毒症患者中，发热的高能量消耗可能会使危及生命的情况恶化。发热控制在 ICU 中被广泛应用，主要用于感染患者。然而，退热药物降低体温的疗效仍然不确定，所有的退热药物都有众所周知的不良反应。体表降温方法有效，但需要镇静以避免寒战的有害影响。最近一项对感染性休克患者的对照试验表明，外部降温控制发热可能会减少血管加压药的需求并改善早期生存。在这篇综述中，我们检查了发热和控制正常体温的益处和风险。讨论了在脓毒症中提供最佳风险/获益比的发热控制方式。
