Abercrombie France,Severe stroke in the initial bo

kingu32vgg4

Severe initial stroke of temperature changes

Stroke is fatal, neurological disease with higher morbidity, is one of the major causes of death of residents [1]. Elevated body temperature after stroke in patients with stroke severity and mortality aspects of the phenomenon of poor outcome is not accidental, but the existence of [2]. After the onset of stroke and stroke than the severity of the damage on their own, but also by many such as age, lesion, hypertension, high blood sugar, heart disease and lung and kidney and other acute cerebral infarction secondary to depression, epilepsy other complications and prompt effective treatment and other factors, temperature is one of them. At present, although there is no separate research reports, has aroused people's attention. Increase in body temperature affect the prognosis of stroke reported in the literature, see. In this paper, our hospital in January 1996 ~ December 2005 treated 607 cases of acute stroke in 87 patients with severe stroke patients after admission to temperature changes and prognosis discussed.
1 clinical data
Accurately measured in all patients after admission axillary temperature, and within 1 week the changes in body temperature ≥ 37.5 ℃ divided into 3 groups: A group, 37.5 ℃ ~ 38.5 ℃; B group, 38.6 ℃ ~ 39 ℃; C group, ≥ 39 ℃. 54 male and 33 females, aged from 31 to 82 years, mean 57 ± 14.3 years old. Cerebral hemorrhage in 59 cases (26 cases of basal ganglia, brain stem in 19 cases, seven cases of the pons, frontal, temporal, parietal occipital 7), blood loss was 9.5 ~ 92.6ml, cerebral infarction, 28 cases (all large area). 1 week killed 68 patients, 11 died after 1 week of survival in 8 cases. 67 cases complicated by infection.
2 diagnostic criteria
All cases were found the Chinese Medical Association in 1995, the Fourth National Cerebrovascular Disease Conference revised diagnostic criteria [3]. And confirmed by brain CT or MR.
3 reasons criteria
(1) infection,[link widoczny dla zalogowanych], after the onset of respiratory, urinary tract, skin infections and other symptoms and signs, and a corresponding auxiliary examination support. (2) central heat: both patients had evidence of brain damage between, there are two forms: one seen occur within 24h after onset of acute fever, persistent up to above 39 ℃, the patient unconscious, to the brain stiffness, the Khan, limb coldness, often die within a few days. The other is long-lasting central heat, the patient may have a coma, bilateral pyramidal tract signs, paroxysmal sweating, pupil size changing, unstable blood pressure, blood sugar and so on. (3) absorption of heat: seamless encephalopathy loss nor infection symptoms,[link widoczny dla zalogowanych], incidence of 3 to 10 days after the emergence of body temperature at about 38 ℃ medium heat or low heat. (4) dehydration heat: the course of dehydration due to the use and ignore a lot of water and electrolyte balance, dehydration symptoms,[link widoczny dla zalogowanych], patients showed fever and consciousness change,[link widoczny dla zalogowanych], laboratory support to make isotonic glucose water or isotonic saline and 5% glucose solution prepared by 1:3 bit effective treatment. (5) re-bleeding,[link widoczny dla zalogowanych], the course of the disease appear repeatedly, and after a fever, lumbar puncture confirmed a fresh bleeding.
4 results
Determined according to the above criteria, the group of 87 patients, infection accounted for 67 cases, central heat accounting for 32 cases, 8 cases absorb heat, and then bleeding in 6 patients, dehydration, fever in 1 case. Among the largest proportion of infections, and infected the majority of respiratory tract infection turned around, followed by urinary tract infection. Of course, the present results to determine the cause of which does not exclude the possibility of overlap, such as central fever with infection may be fever, the clinician must carefully evaluate and judge.
5 discussions
Cerebral vascular disease with fever many reasons. Data is reported that combined acute fever about 40% [4], and to incorporate the most common infection caused by body temperature. Acute cerebrovascular disease especially in patients with coma due to a small cough, sputum and poor discharge secretions, aspiration of food and vomiting, poor oral hygiene, combined with poor general condition, the overall dysfunction of the brain, immune dysfunction, nutritional insufficiency, it is prone to upper respiratory and lung infections; also some patients with urinary tract infection in the past or have line catheterization or indwelling catheter, after the onset of illness concurrent urinary tract infection, poor oral hygiene can cause mouth inflammation can cause pressure sores due to improper care and so on. Therefore, in the treatment of acute cerebral vascular diseases, the prevention of infection is very important. Another reason is the central cause fever heat, central heat is due to lesions of the central regulation of body temperature caused by fever.
Intraventricular hemorrhage or severe cerebral hemorrhage caused by high fever occur within the 24h, the lower survival rate in these patients; and the other for the more persistent fever, and evidence of damage between the brain, possibly due to more minor direct impact on cerebral hemorrhage or indirect effects such as arterial spasm. There is also a cause of fever is to absorb heat, which is due to destruction of red blood cells after hemorrhage when the ingredients are absorbed into the bloodstream caused by the reaction temperature is not high, mainly in patients with subarachnoid hemorrhage, cerebral hemorrhage or mild patients. Yet another reason is that re-bleeding fever, especially in patients with subarachnoid hemorrhage, if not pay attention to the limitations of time in bed early activities, rebleeding may occur, except in patients with headache and neck stiffness and other manifestations of repeated, there are Patients may be combined fever, can be confirmed by lumbar puncture or CT. In addition, due to neglect of water and electrolyte balance and excessive dehydration can lead to cellular dehydration caused by fever, less common but still need attention. Of course, cerebrovascular disease, and fever during the acute phase of the reasons there: If ventilation may also cause fever, in addition, some patients in the treatment of infections by the use of antibiotics when symptoms of infection after the disappearance of the body temperature did not fall or even higher, should be Taking into account the possibility of drug fever.
Prognosis of acute cerebral infarction affect many factors, including age, location and severity of disease, hypertension, high blood sugar, heart lung and kidney complications, and depression after acute cerebral infarction, epilepsy and other complications, and timely and effective treatment. On body temperature affect the prognosis of acute cerebral infarction have been reported in the literature, see.
Animal experiments have proved [5] changes in body temperature affect the mortality of cerebral infarction, but the impact on human cerebral infarction remains unclear, fever, short-term morbidity of acute cerebral infarction has directly affected, their mortality rate also affected. Hypothermia has a protective effect against cerebral infarction has been confirmed [6]. Observations: body temperature <37.5 ℃ group to light the majority of stroke patients, body temperature ≥ 37.5 ℃ group were managed with heavy stroke were more common. Meanwhile, the study found that body temperature ≥ 37.5 ℃ group outcome and death were associated with body temperature <37.5 ℃ group vary widely. Associated with disease, more severe neurological impairment, the mortality rate was also high. In the present study found that stroke patients with elevated body temperature after stroke severity, poor outcome aspects of the phenomenon of mortality is not accidental, but indeed exist.
Has been reported that [4], 72h after cerebral infarction mortality was significantly elevated body temperature increased, but the 24h body temperature within the disability rate is higher, the study found that 1 week in body temperature, their mortality and morbidity also increased.
Type in stroke patients with no difference between the composition, but Tiwen ≥ 37.5 ℃ group than in the clinical manifestations of stroke Tiwen <37.5 ℃ group of patients to serious, Incidence rates with heavier and heavier neurological deficits. Tip body temperature and stroke severity there may be a relationship, and this relationship has affected stroke outcome after stroke.
More serious stroke in patients who, either cerebral infarction or cerebral hemorrhage, temperature rise will occur, and the temperature increased in the patients showed only a few hours after stroke symptoms appear, thus speculated that increased body temperature due to cerebral infarction or cerebral hemorrhage and the size of lesions caused by subsequent tumor necrosis and edema may also be important. Have speculated that elevated body temperature and lesion size. Body temperature with larger infarcts, more severe neurologic impairment independent relationship exists between.