内镜手术治疗自发性脑出血术后发热与临床转归的回顾性数据库研究。
Postoperative fever and clinical outcomes after endoscopic surgery for spontaneous intracerebral hemorrhage: a retrospective database study.
机构信息
Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, No. 399, Wanyuan Road, Shanghai, 201102, China.
出版信息
BMC Neurol. 2024 Oct 15;24(1):392. doi: 10.1186/s12883-024-03898-4.
BACKGROUND
Spontaneous intracerebral hemorrhage (SICH) is a severe stroke with high mortality and disability rates. Endoscopic surgery is an increasingly widely used minimally invasive method for the treatment of SICH. However, the impact of fever on patient outcomes remains unclear.
METHODS
We retrospectively included patients aged 18 years or older with supratentorial SICH confirmed by CT, who underwent endoscopic hematoma evacuation within 48 h of symptom onset. The primary outcome was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included hospital and neurosurgical intensive care unit (NSICU) stays, and perioperative complications. We analyzed the association between postoperative fever (highest temperature within 24 h after surgery) and these outcomes using multivariate analysis, generalized additive models, and segmented regression analysis.
RESULTS
Of the 56 patients, 38 had favorable outcomes (mRS ≤ 3) and 18 had unfavorable outcomes (mRS > 3) at 3 months. A threshold effect at 38.2 °C was observed between postoperative body temperature and clinical outcomes. The mean age was 56 years (SD = 9) for the > 38.2 °C group and 58 years (SD = 8) for the ≤ 38.2 °C group, with a similar proportion of male patients (63% vs. 69%, P = 0.635). Patients with postoperative fever had larger hematoma volumes (65 vs. 56 mL; P = 0.008). Other characteristics were similar between the groups. Postoperative fever (> 38.2 °C) was independently associated with a 4.99-fold increased risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P = 0.040), which remained significant after excluding patients with postoperative complications (adjusted RR = 16.03, 95% CI = [1.69 to 417.24]; P = 0.033). The association was consistent across subgroups with different Glasgow Coma Scale scores, hematoma volumes, and intraventricular extension. Postoperative fever was also associated with longer NSICU stays (3.1 vs. 2.3 days; P = 0.023), longer hospital stays (17.2 vs. 13.6 days; P = 0.010), more residual hematoma, and greater edema volume. Different antipyretic therapies did not affect outcomes.
CONCLUSIONS
This study identifies a temperature threshold (38.2 °C) associated with poor outcomes in SICH patients undergoing endoscopic surgery. Further research is needed to mitigate postoperative fever and improve patient outcomes.
背景
自发性脑出血（SICH）是一种死亡率和致残率很高的严重中风。内镜手术是一种越来越广泛应用的微创方法，用于治疗 SICH。然而，发热对患者预后的影响仍不清楚。
方法
我们回顾性纳入了经 CT 证实的幕上 SICH 患者，年龄在 18 岁及以上，在症状出现后 48 小时内接受内镜血肿清除术。主要结局为术后 3 个月的改良 Rankin 量表（mRS）评分。次要结局包括住院和神经外科重症监护病房（NSICU）住院时间以及围手术期并发症。我们使用多变量分析、广义加性模型和分段回归分析，分析术后发热（术后 24 小时内最高体温）与这些结局之间的关系。
结果
56 例患者中，38 例（mRS≤3）在术后 3 个月时预后良好，18 例（mRS＞3）预后不良。术后体温与临床结局之间观察到 38.2°C 的阈值效应。＞38.2°C 组的平均年龄为 56 岁（标准差[SD]＝9），≤38.2°C 组为 58 岁（SD＝8），男性患者比例相似（63% vs. 69%，P＝0.635）。发热组的血肿体积更大（65 毫升 vs. 56 毫升；P＝0.008）。两组其他特征相似。术后发热（＞38.2°C）与不良结局的风险增加 4.99 倍独立相关（95%CI = [1.13 至 25.90]；P＝0.040），排除术后并发症患者后仍具有显著意义（调整后的 RR＝16.03，95%CI = [1.69 至 417.24]；P＝0.033）。该关联在不同格拉斯哥昏迷量表评分、血肿体积和脑室内延伸的亚组中一致。术后发热还与 NSICU 住院时间延长（3.1 天 vs. 2.3 天；P＝0.023）、住院时间延长（17.2 天 vs. 13.6 天；P＝0.010）、残余血肿更多和水肿体积更大有关。不同的退热治疗并未影响结局。
结论
本研究确定了内镜手术治疗 SICH 患者与不良结局相关的体温阈值（38.2°C）。需要进一步研究以减轻术后发热并改善患者预后。
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