Nakajima Yasufumi
Department of Anesthesiology and Intensive Care, Kansai Medical University, Shinmachi 2-3-1, Hirakata, Osaka, 573-1191, Japan.
J Anesth. 2016 Oct;30(5):873-83. doi: 10.1007/s00540-016-2200-7. Epub 2016 Jun 28.
Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down. A recent upsurge in clinical evidence in the perioperative and critical care field resulted in many clinical trials in temperature management. The results of these clinical trials suggest that aggressive body temperature modifications in comatose survivors after resuscitation from shockable rhythm, and permissive fever in critically ill patients, are carried out in critical care settings to improve patient outcomes; however, its efficacy remains to be elucidated. A recent, large multicenter randomized controlled trial demonstrated contradictory results, which may disrupt the trends in clinical practice. Thus, updated information concerning thermoregulatory interventions is essential for anesthesiologists and intensivists. Here, recent controversies in therapeutic hypothermia and fever management are summarized, and their relevance to the physiology of human thermoregulation is discussed.
尽管体温是一项典型的主要生命体征，但与其他生命体征（血压、心率和呼吸频率）相比，其价值很少受到关注。这可能是因为与其他主要生命体征不同，衰老和疾病很少影响体温调节系统。尽管如此，在围手术期和重症监护环境中，当人类接触各种麻醉剂、镇痛药以及非感染性和感染性疾病的急性病因时，可能会出现体温上下波动的异常情况。围手术期和重症监护领域近期临床证据的激增导致了许多体温管理方面的临床试验。这些临床试验的结果表明，在重症监护环境中，对可电击心律复苏后的昏迷幸存者进行积极的体温调节，以及对重症患者采取允许发热的措施，以改善患者预后；然而，其疗效仍有待阐明。最近一项大型多中心随机对照试验得出了相互矛盾的结果，这可能会扰乱临床实践的趋势。因此，有关体温调节干预的最新信息对麻醉医生和重症医生至关重要。在此，总结了治疗性低温和发热管理方面最近的争议，并讨论了它们与人体体温调节生理学的相关性。
