The Effects of Brain Temperature Changes on Intracranial Pressure, Cerebral Perfusion Pressure and Prognosis after Traumatic Brain Injury

腦創傷後腦溫的變化於顱內壓腦灌流壓及預後的影響

本研究主要在探討當腦傷病人試圖維持正常腦溫的狀態下，腦壓、腦灌流壓、昏迷指數及顱內溫度改變的關係。共收集28位腦傷病人，依標準手術程序將腦壓及腦溫監視器植入受傷大腦半球的腦實質3公分深，腦壓、腦灌流壓、腦溫及肛溫每小時記錄共記錄三天，三個月後再次評估病人的格拉斯哥預後指數 (Glasgow Outcome Scale, 以下簡稱GOS)。在存活及死亡病例中發現腦溫、腦壓及腦灌流壓有明顯的差異。在存活病人中則看不到腦壓及腦溫(Rho=0.373, p=0.080)、腦灌流壓和腦溫(Rho=0.334, p=0.119)的相關性。腦溫對於腦壓(p<0.001)及腦灌流壓(p=0.021)則有明顯的影響。在GOS 2至3分的病人中，24小時內(p=0.043)及96小時內(p<0.001)有較高的機會出現腦高溫(相對於GOS為4至5的病人)。全身體溫及腦溫差在不同的GOS病人中(GOS 1, GOS 2+3, and GOS 4+5)也可看到明顯的差異(p<0.001)。腦溫的改變比腦溫監測對於腦壓及腦灌流壓有較明顯的影響。入院後24及96小時內出現高溫跟三個月後較差的Glasgow 預後指數有關。腦溫調控的異常將造成較高的腦溫及體溫的差異也預告著較差的預後。

The aim of study was to assess the relationship between intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow Outcome Scale (GOS) and intracranial temperature change (ΔICT) when attempting to keep the brain in normothermia in patients with brain injury. Totally 28 patients were enrolled. ICP, CPP, ICT and rectal temperature (Tr) were recorded every hour for 4 days. A standardized procedure was followed, in which an ICP/ICT coupled probe was implanted at 3-cm depth in the parenchyma of the injured hemisphere, and GOS at three months was evaluated. There were significant differences in ICT, ICP, and CPP between surviving and non-surviving patients. Spearman’s correlation revealed no link between ICP and ICT (Rho=0.373, p=0.080), and CPP and ICT (Rho=0.334, p=0.119) in surviving patients. When considering the temperature change, ICT had a significant influence on ICP (p<0.001) and CPP (p=0.021). The incidence of brain hyperthermia in patients with GOS of 2 or 3 was higher than patients who scored 4 or 5 within 24 hours (p=0.043), and within 96 hours of admission (p<0.001). The relationship between systemic-brain temperature gradient ΔT brain -rectal with outcomes (GOS 1, GOS 2+3, and GOS 4+5) was also shown to be significant (p<0.001). Brain temperature change had more significant effects on ICP and CPP than brain temperature monitoring. Hyperthermia within 24 hours and 96 hours of admission was associated with a worse GOS at 3 months. A loss of temperature regulation, indicating high gradient of ΔT brain -rectal was accompanied with a poor outcome.