Provencio J Javier, Badjatia Neeraj
Cleveland Clinic Lerner College of Medicine, NC30, 9500 Euclid Ave., Cleveland, OH, 44195, USA,
Neurocrit Care. 2014 Dec;21 Suppl 2:S177-86. doi: 10.1007/s12028-014-0038-0.
Inflammation is an important part of the normal physiologic response to acute brain injury (ABI). How inflammation is manifest determines if it augments or hinders the resolution of ABI. Monitoring body temperature, the cellular arm of the inflammatory cascade, and inflammatory proteins may help guide therapy. This summary will address the utility of inflammation monitoring in brain-injured adults. An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure inflammation in ABI. Ninety-four articles were included in this review. Current evidence suggests that control of inflammation after ABI may hold promise for advances in good outcomes. However, our understanding of how much inflammation is good and how much is deleterious is not yet clear. Several important concepts emerge form our review. First, while continuous temperature monitoring of core body temperature is recommended, temperature pattern alone is not useful in distinguishing infectious from noninfectious fever. Second, when targeted temperature management is used, shivering should be monitored at least hourly. Finally, white blood cell levels and protein markers of inflammation may have a limited role in distinguishing infectious from noninfectious fever. Our understanding of optimal use of inflammation monitoring after ABI is limited currently but is an area of active investigation.
炎症是急性脑损伤（ABI）正常生理反应的重要组成部分。炎症的表现方式决定了它是促进还是阻碍ABI的恢复。监测体温、炎症级联反应的细胞环节以及炎症蛋白可能有助于指导治疗。本综述将探讨炎症监测在成年脑损伤患者中的应用。我们进行了一项电子文献检索，查找描述ABI炎症检测、应用及最佳测量方法的英文文章。本综述纳入了94篇文章。目前的证据表明，控制ABI后的炎症可能为改善预后带来进展。然而，我们对于多少炎症是有益的以及多少是有害的尚不清楚。我们的综述得出了几个重要概念。首先，虽然建议持续监测核心体温，但仅温度模式在区分感染性发热和非感染性发热方面并无用处。其次，当采用目标温度管理时，应至少每小时监测一次寒战情况。最后，白细胞水平和炎症蛋白标志物在区分感染性发热和非感染性发热方面的作用可能有限。目前我们对ABI后炎症监测的最佳应用的理解有限，但这是一个正在积极研究的领域。
