摘要目的 探究颅脑创伤患者术后脑温(包括脑室内、脑实质内或硬脑膜下腔)、腋温、肛温和膀胱温度之间的关系,以及脑温与患者预后之间的关系.方法 多中心前瞻性连续纳入2016年3月至12月期间11家医院的83例颅脑创伤患者,每小时记录患者术后至拔除脑温监测探头期间脑温、腋温、肛温、膀胱温度的变化.结果 不同部位的脑温和腋温的差值相比较,硬膜下的温差[中位数(P25,P75):0.10(-0.40,0.40)℃]低于脑实质内的温差[0.30(-0.20,0.90)℃]和脑室内的温差[0.60(0.20,1.00)℃](均P＜0.05);脑实质内的温差低于脑室内的温差(P＜0.05).不同部位的脑温与肛温、膀胱温度的差值相比较,硬膜下的温差[分别为-0.20(-0.40,0.00)℃,-0.10(-0.30,0.00)℃]低于脑实质内的温差[分别为0.10(-0.10,0.20)℃,0.10(0.00,0.20)℃],更低于脑室内的温差[分别为0.20(0.10,0.30)℃,0.20(0.10,0.30)℃](均P＜0.05).无论是否进行亚低温治疗,脑温与腋温的差值大于脑温与肛温、膀胱温度的差值(均P ＜0.05).当脑温＞38℃时,脑温与腋温的差值＞脑温与肛温的差值＞脑温与膀胱温度的差值(均P ＜0.05);当脑温≤38℃时,脑温与腋温的差值＞脑温与膀胱温度的差值＞脑温与肛温的差值(均P ＜0.05).当术后12 h脑温波动＞1℃时,则术前格拉斯哥昏迷评分(GCS)、出院时扩展格拉斯哥预后评分(GOS-E)均显著低于术后12 h脑温波动≤1℃的患者(均P＜0.05).结论 脑温监测对颅脑创伤具有重要的临床价值.当没有条件直接监测脑温时,监测膀胱温度最能反映脑温的情况.

abstractsObjective To investigate the relationship of brain temperature (intra-ventricle,brain parenchyma,or subdural space) to axillary temperature,rectal temperature and bladder temperature in postoperative patients with brain trauma,and to explore the prognosis value of the brain temperature through a multicenter prospective observational study.Methods A total of 83 patients with brain trauma at 11 hospitals were enrolled to this study from March 2016 to December 2016.The data including patients'brain temperatures,axillary temperatures,rectal temperatures and bladder temperatures were hourly documented postoperatively until withdrawal of monitoring device of brain temperatures.The changes of the values were then further analyzed.Results Compared with the axillary temperature,the subdural temperature difference [0.10(-0.40,0.40) ℃] was less than intraventricular temperature difference [0.30(-0.20,0.90) ℃],which was less than parenchymal temperature difference [0.60 (0.20,1.00) ℃] (both P ＜0.05).Compared with rectal temperature and bladder temperature,the subdural temperature difference [-0.20 (-0.40,0.00) ℃,-0.10 (-0.30,0.00) ℃,respectively] was less than parenchymal temperature difference [0.10 (-0.10,0.20) ℃,0.10 (0.00,0.20) ℃,respectively],which was less than intraventricular temperature difference [0.20 (0.10,0.30) ℃,0.20 (0.10,0.30) ℃,respectively] (all P ＜ 0.05).No matter whether hypothermia treatment was administered,the difference between brain temperature and axillary temperature (△TBr-Ax) was larger than that between brain temperature and rectal temperature (△TBr-Re) and that between brain temperature and bladder temperature (△TBr-Bl) (both P ＜0.05).When brain temperature was higher than 38 ℃,△TBr-Ax was larger than △TBr-Re,which was larger than △TBr-Bl (both P ＜ 0.05).When brain temperature was less than or equal to 38 ℃,△TBr-Ax was larger than △TBr-Bl,which was larger than △TBr-Re (both P ＜ 0.05).When the fluctuation of brain temnperature within 12 hours post operation was more than 1 ℃,the preoperative Glasgow coma scale (GCS) and the extended Glasgow outcome scale (GOS-E) at discharge were significantly lower compared with those of cases whose brain temperature fluctuation was less than or equal to 1 ℃ (both P ＜ 0.05).Conclusions For patients with brain trauma,brain temperature monitoring seems to have a very significant clinical value.When monitoring of brain temperature is not available,the bladder temperature might serve as the best reflection of brain temperature.