Behr R, Ehrlinspiel D, Christophis P
Department of Neurosurgery, University of Würzburg, Federal Republic of Germany.
Acta Neurochir (Wien). 1996;138(2):192-9. doi: 10.1007/BF01411360.
24 patients, 16 after severe head injury and 8 after spontaneous intracranial haematoma, were investigated by external cold load in order to determine their thermoregulatory capabilities. Tympanic temperature, several skin temperatures and oxygen consumption were measured. The patients where examined for SSEP and AEP. The cold induced thermoregulatory threshold temperature was determined by calculating the mean body temperature and by determining mean body temperature at which oxygen consumption increased due to the external cold load. In all patients core temperature and mean body temperature were significantly elevated by 1 degree C compared to controls. There was no difference of the course of the various body temperatures during cold load in the patient groups. In the trauma group 8 patients were able to increase oxygen use (VO2) during cold exposure, the other 8 patients showed no physiological thermoregulatory reaction. The heatproduction threshold temperature was increased by 1 degree C in the patient groups compared to controls. There was no significant correlation of AEP and SSEP findings to a preserved or disturbed thermoregulatory reaction. In the trauma patients, who were able to respond to a cold load, the outcome was significantly better (GOS = 3-5), than in those patients, who did not show a physiological increase of VO2 due to the cold load (GOS = 1-2). In conclusion, measurement of body temperatures alone is not sufficient to determine termoregulatory capacities. An examination using thermophysiological methods however provides more information about the function and structure damaged after severe head injury. An intact thermoregulatory systems seems to be correlated with a better prognosis after head injury.
对24例患者进行了外部冷负荷测试，以确定其体温调节能力，其中16例为重度颅脑损伤患者，8例为自发性颅内血肿患者。测量了鼓膜温度、多个皮肤温度和耗氧量。对患者进行了体感诱发电位（SSEP）和听觉诱发电位（AEP）检查。通过计算平均体温以及确定因外部冷负荷导致耗氧量增加时的平均体温，来确定冷诱导体温调节阈值温度。与对照组相比，所有患者的核心体温和平均体温均显著升高1℃。各患者组在冷负荷期间各种体温的变化过程无差异。在创伤组中，8例患者在冷暴露期间能够增加耗氧量（VO2），另外8例患者未表现出生理性体温调节反应。与对照组相比，患者组的产热阈值温度升高了1℃。AEP和SSEP检查结果与体温调节反应保存或受损之间无显著相关性。在能够对冷负荷作出反应的创伤患者中，其预后（格拉斯哥预后评分GOS=3-5）明显好于那些因冷负荷未出现VO2生理性增加的患者（GOS=1-2）。总之，仅测量体温不足以确定体温调节能力。然而，采用热生理方法进行检查可提供更多关于重度颅脑损伤后功能和结构损伤的信息。完整的体温调节系统似乎与颅脑损伤后较好的预后相关。
