早期发热作为创伤性脑损伤中阵发性交感神经过度兴奋的预测指标
Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury.
作者信息
Hinson Holly E, Schreiber Martin A, Laurie Amber L, Baguley Ian J, Bourdette Dennis, Ling Geoffrey S F
机构信息
Departments of Neurology (Drs Hinson and Bourdette), Emergency Medicine (Dr Hinson and Ms Laurie), and Trauma, Critical Care & Acute Surgery (Dr Schreiber), Oregon Health & Science University, Portland; Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, New South Wales, Australia (Dr Baguley); and Biological Technologies Office, Defense Advanced Research Projects Agency, Bethesda, Maryland (Dr Ling).
出版信息
J Head Trauma Rehabil. 2017 Sep/Oct;32(5):E50-E54. doi: 10.1097/HTR.0000000000000271.
OBJECTIVE
Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH.
SETTING/PARTICIPANTS/DESIGN: We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis).
MAIN MEASURES
The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization.
RESULTS
Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40).
CONCLUSION
Early fever after TBI may signal impending autonomic dysfunction.
目的
创伤性脑损伤（TBI）后，阵发性交感神经过度兴奋（PSH）的特征是生命体征出现发作性、高肾上腺素能改变。我们试图应用一种客观量表来评估PSH患者生命体征的改变，以确定是否有一个因素可以预测PSH的发生。
设置/参与者/设计：我们对连续的TBI患者（格拉斯哥昏迷量表评分≤12）进行了一项观察性研究，并监测该队列中PSH的临床证据。PSH被定义为具有以下3种或更多特征的发作：（1）心动过速，（2）呼吸急促，（3）高血压，（4）发热，（5）肌张力障碍（僵硬或去大脑强直姿势），以及（6）多汗，且无其他明显病因（即酒精戒断、败血症）。
主要测量指标
在住院的前5天，每天对每位参与者应用改良临床特征严重程度量表（mCFSS）一次。
结果
167例患者中有19例（11%）符合PSH标准。PSH患者的5天累积mCFSS评分高于无PSH患者（中位数[四分位间距]=36[29 - 42]对29[22 - 35]，P = 0.01）。在mCFSS的4个组成部分中，体温升高似乎最能预测PSH的发生，尤其是在最初24小时内（比值比=1.9；95%置信区间，1.12 - 3.40）。
结论
TBI后早期发热可能预示即将出现自主神经功能障碍。
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