急性重症脑卒中患者非感染性发热的危险因素

Predictors of non-infectious fever in patients with acute stroke

目的:探讨急性重症脑卒中患者非感染性发热的危险因素。方法:对湘雅三医院2006年3月至2007年10月神经重症监护病房(NICU)中住院的急性重症脑卒中患者进行观察。把2次测量体温高于37.5℃或1次测量体温高于37.8℃者确定为发热;没有查到感染证据的发热患者判定为非感染性发热。对非感染性发热患者的危险因素首先进行单因素分析,然后进行多因素logistic回归分析,确定高危因素。结果:206例患者中有95例患者出现发热,其中非感染性发热33例。单因素分析结果表明,意识障碍、脑干卒中、蛛网膜下腔出血、入院72h内出现发热、脑中线移位、入院时血糖、入院时白细胞计数、出现应激性溃疡的患者易于出现非感染性发热(P<0.05);多因素logistic回归分析结果表明,蛛网膜下腔出血、72 h内出现发热、脑中线移位是非感染性发热的高危因素。结论:在蛛网膜下腔出血和脑中线移位的急性重症脑卒中患者中,早期发热多数是非感染性发热。

Objective To evaluate the predictors of non-infectious fever in patients with acute stroke treated. Methods Prospective data collection of consecutive patients admitted to the neurological intensive care unit （NICU） of an academic medical centre was carried out. Febrile patients with no proven evidence of infection were considered to have non-infectious fever. After the univariate analysis was tested the variables between the infectious and non-infectious fever, the logistic regression analysis was used to ascertain the risk factors for non-infectious fever. Results Ninety-five patients were included in the final analysis. Fever was non-infectious in 33 patients. There were statistically significance between the infectious and non-infectious fever groups in terms of conscious disturbance, brain stem stroke, subarachnoid hemorrhage, onset of fever within the first 72 h of admission, brain midline shift, initial serum glucose, leucocyte counts on admission, and stress ulcer. Muhivariable logistic regression analysis demonstrated that subarachnoid hemorrhage, the onset of fever within the first 72 h of admission, and brain midline shift were involved into regression equation for non-infectious fever. Conclusion Early onset of fever predicts a non-infectious cause in patients especially with subarachnoid haemorrhage and brain midline shift.