大脑半球大面积脑梗死患者急性期体温与预后

Body temperature and prognosis in patients with massive hemispheric infarction in acute phase

目的探讨大脑半球大面积脑梗死（massive hemispheric infarction,MHI）患者急性期（发病7d内）体温与预后的关系。方法对102例MHI患者体温进行动态观察，分析48h内、72h～7d两个时间段体温（正常体温、轻度升高体温和显著升高体温）与预后的相关性。预后评价时间为发病后3个月，评估指标为病死率和改良Ranldn量表（modified Rarlkirl Score，mRS）评分。结果发病48h内体温轻度升高（OR=1．45，95％CI0．63～3．32）和显著升高（OR=7．70，95％CI0．95～62．40）均会增高3个月时死亡风险，但未达到统计学意义；体温轻度升高（OR=2．74，95％CI1．05～7．13；P=0．04）能显著增高3个月时功能转归不良（mRS评分5～6分）风险，而体温显著升高则不然（OR=4．58，95％CI0．56～37．4）。发病72h～7d期间体温轻度升高（OR=3．39，95％CI1．33～8．61；P=0．01）和显著升高（OR=7．64，95％CI2．10～27．68；P=0．002）仅与死亡风险增高有关，而与功能转归不良无关。Logistic多变量分析表明，发病72h～7d期间体温轻度升高（OR=3．15，95％CI1．28～8．09；P=0．02）和显著升高（OR=7．20，95％CI2．03～25．12；P=0．01）均显著增高3个月时的死亡风险。结论MHI急性期患者体温升高是预后不良的独立危险因素，发病7d内应积极采取降温措施，使体温维持在正常范围。

Objective To investigate the correlation between the body temperature and the prognosis in patients with massive hemispheric infarction in acute phase （within 7 days after the onset）. Methods 1he temperatures of 102 patients with massive hemispheric infarction were observed dynamically. the correlation between the temperatures of the two time periodswithin 48 hours and from 72 hours to 7 days （normal temperature, mild increased temperature, and significantly increased temperature） and the prognosis were analyzed. The evaluation time of the prognosis was at 3 months after the symptom onset. The evaluation indicators were the mortality and the modified Ranldn Score （mRS） scales. Results Both the mild increased temperature （OR = 1.45, 95% CI 0.63 to 3.32） and the significantly increased temperature （OR =7.70, 95% CI 0.95 to 62.40） increased the risks of death within 48 hours, however, they did not reach statistical significance; the mild increased temperature （OR =2.74, 95% CI 1.05 to 7.13; P = 0.04） significantly increased the risk of the poor functional outcome at 3 months （mRS scores 5 to 6）, while the significantly increased temperature was not so （OR = 4.58, 95% CI 0.56 to 37.4）. The temperatures increased slightly （OR=3.39, 95% CI 1.33 to 8.61, P =0.01） and significantly （OR =7.64, 95% CI 2.10 to 27.68, P =0. 0.02） from 72 hours to 7 days after the symptom onset were only associated with the increased risks of death, and were not associated with the poor functional outcomes. Multivariate Logistic regression analysis demonstrated that both the mild （OR =3.15, 95% CI 1.28 to 8.09, P = 0.02） or significantly （OR =7.20, 95% CI 2.03 to 25.12, P =0.01） increased temperature from 72 hour to 7 days during the symptom onset were significantly increased the risk of death at 3 months. Conclusions The increased temperature in patients with massive hemispheric infarction in acute phase is an independent risk factor for poor prognosis. Active measures of decreasing temperature should be taken within 7 days of the onset in order to maintain a normal temperature range.