Rivera-Lara Lucia, Kowalski Robert G, Schneider Eric B, Tamargo Rafael J, Nyquist Paul
Department of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
Department of Neurology, Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
J Clin Neurosci. 2015 Oct;22(10):1582-7. doi: 10.1016/j.jocn.2015.03.033. Epub 2015 Jul 3.
We have previously reported an increase of 0.6% in the relative risk of aneurysmal subarachnoid hemorrhage (aSAH) in response to every 1°F decrease in the maximum daily temperature (Tmax) in colder seasons from patients presenting to our regional tertiary care center. We hypothesized that this relationship would also be observed in the warmer summer months with ambient temperatures greater than 70°F. From prospectively collected incidence data for aSAH patients, we investigated absolute Tmax, average daily temperatures, intraday temperature ranges, and the variation of daily Tmax relative to 70°F to assess associations with aSAH incidence for patients admitted to our institution between 1991 and 2009 during the hottest months and days on which Tmax>70°F. For all days treated as a group, the mean Tmax (± standard deviation) was lower when aSAH occurred than when it did not (64.4±18.2°F versus 65.8±18.3°F; p=0.016). During summer months, the odds ratio (OR) of aSAH incidence increased with lower mean Tmax (OR 1.019; 95% confidence interval 1.001-1.037; p=0.043). The proportion of days with aSAH admissions was lower on hotter days than the proportion of days with no aSAH (96% versus 98%; p=0.006). aSAH were more likely to occur during the summer and on days with a temperature fluctuation less than 10°F (8% versus 4%; p=0.002). During the hottest months of the year in the mid-Atlantic region, colder maximum daily temperatures, a smaller heat burden above 70°F, and smaller intraday temperature fluctuations are associated with increased aSAH admissions in a similar manner to colder months. These findings support the hypothesis that aSAH incidence is more likely with drops in temperature, even in the warmer months.
我们之前曾报道，在较寒冷的季节，每出现最高日气温（Tmax）下降1华氏度，我院区域三级医疗中心收治的患者发生动脉瘤性蛛网膜下腔出血（aSAH）的相对风险就会增加0.6%。我们推测，在夏季气温高于70华氏度的温暖月份，这种关系也会出现。我们利用前瞻性收集的aSAH患者发病率数据，调查了绝对Tmax、日均气温、日内温度范围以及相对于70华氏度的每日Tmax变化，以评估1991年至2009年期间我院收治的患者在最热月份且Tmax>70华氏度的日子里，这些因素与aSAH发病率之间的关联。将所有日子作为一个整体来看，发生aSAH时的平均Tmax（±标准差）低于未发生时（64.4±18.2华氏度对65.8±18.3华氏度；p = 0.016）。在夏季月份，aSAH发病率的比值比（OR）随着平均Tmax降低而升高（OR 1.019；95%置信区间1.001 - 1.037；p = 0.043）。aSAH入院的日子比例在较热的日子低于无aSAH的日子比例（96%对98%；p = 0.006）。aSAH更有可能在夏季以及温度波动小于10华氏度的日子发生（8%对4%；p = 0.002）。在大西洋中部地区一年中最热的月份，与较寒冷月份类似，最高日气温较低、高于70华氏度的热负荷较小以及日内温度波动较小与aSAH入院增加相关。这些发现支持了这样的假设，即即使在温暖月份，aSAH发病率也更有可能随着温度下降而升高。
