Department of Neurosurgery, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
Department of Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.
Neurosurgery. 2022 Dec 1;91(6):863-871. doi: 10.1227/neu.0000000000002122. Epub 2022 Sep 9.
Although targeted temperature management (TTM) may mitigate brain injury for severe subarachnoid hemorrhage (SAH), rebound fever correlates with poor outcomes.
To study the effect of endovascular TTM after rewarming from initial surface cooling during a high-risk period for delayed cerebral ischemia.
We studied patients with World Federation of Neurological Surgeons grade V SAH before and after the introduction of endovascular TTM. Both groups (36 patients each) were treated with TTM at 34 °C with conventional surface cooling immediately after SAH diagnosis, together with emergency aneurysm repair. When rewarmed to 36 °C, around 7 days later, the study group underwent TTM at 36 to 38 °C for 7 days with an endovascular cooling system. The control group was treated with antipyretics.
Sex, age, Glasgow Coma Scale score, modified Fisher computed tomography classification, aneurysm location, and treatment methods were not different between the study and control groups. Differences were detected in the incidence of fever >38 °C (13 vs 26 patients, P = .0021), duration of fever >38 °C (4.1 vs 18.8 hours, P = .0021), incidence of vasospasm-related cerebral infarction (17% vs 42%, P = .037), and the likelihood of excellent outcomes (0 and 1 on a modified Rankin Scale) at 6 months (42% vs 17%, P = .037). In endovascular TTM, shivering occurred more frequently in patients with better outcomes, requiring aggressive treatment to avoid fever.
Endovascular TTM at 36 to 38 °C after surface cooling was feasible and safely performed in patients with severe SAH. Combined TTM for 2 weeks was associated with a lower incidence of vasospasm-related infarction and may improve outcomes.
尽管目标温度管理（TTM）可能减轻严重蛛网膜下腔出血（SAH）的脑损伤，但反弹热与不良结局相关。
研究在迟发性脑缺血高危期内从初始表面冷却复温后进行血管内 TTM 的效果。
我们研究了 WFNS 分级 V SAH 患者在引入血管内 TTM 前后的情况。两组（每组 36 例）均在 SAH 诊断后立即采用 TTM 进行 34°C 治疗，同时进行紧急动脉瘤修复。当复温至 36°C 左右时，即 7 天后，研究组使用血管内冷却系统进行 36 至 38°C 的 TTM 治疗 7 天。对照组则采用退热治疗。
研究组和对照组之间的性别、年龄、格拉斯哥昏迷评分、改良 Fisher CT 分级、动脉瘤位置和治疗方法均无差异。两组在发热 >38°C 的发生率（13 例 vs 26 例，P =.0021）、发热持续时间 >38°C（4.1 小时 vs 18.8 小时，P =.0021）、血管痉挛相关脑梗死的发生率（17% vs 42%，P =.037）以及 6 个月时改良 Rankin 量表评分（0 和 1）的优良结局发生率（0%和 17%，P =.037）方面存在差异。在血管内 TTM 中，预后较好的患者更常出现寒战，需要积极治疗以避免发热。
在严重 SAH 患者中，表面冷却后进行 36 至 38°C 的血管内 TTM 是可行且安全的。联合 2 周的 TTM 与较低的血管痉挛相关梗死发生率相关，并可能改善结局。
