2013 年 36 巻 1 号 p. 60-66
Objective: This study evaluated the clinical characteristics and effects of brain temperature control in severe traumatic brain injury patients based on traumatic pathophysiology.
Methods: A total of 1091 patients were registered in Japan Neurotrauma Data Bank Project 2009. Of these patients, those with a Glasgow Coma Scale (GCS) score of 9 or more, and a GCS of 3 and bilateral dilated pupils, as well as cardiopulmonary arrest on arrival, were excluded. This left a total of 401 patients. These patients were classified into three groups: no control of brain temperature (F group: 225 patients, 56.1%), intensive normothermia (N group: 129 patients, 32.2%), and hypothermia (H group: 47 patients, 11.7%). We examined the patients' age, GCS, pupillary abnormality, Injury Severity Score (ISS), intracranial pressure (ICP) monitoring, rate of favorable outcome, and mortality according to CT classification (TCDB classification) on admission.
Results: In diffuse injury III, the implementation rate of brain temperature control was high (F group: 13.8%, N group: 62.1%, H group: 24.1%). Patients were significantly older in the F group (average age: 61.5 y.o.) compared with the N group (53.6 y.o.) and H group (46.9 y.o.). There were no significant differences in GCS, papillary abnormality, and ISS between all groups. The rate of ICP monitoring performance was significantly decreased in 85.1% of patients in the H group, 42.6% in the N group, and 14.7% in the F group. The rate of favorable outcome was significantly high in the H group (52.4%) compared with the N group (26.9%) and the F group (20.7%) with evacuated mass lesion.
Conclusion: The cases that underwent brain temperature control also recieved ICP monitoring. Hypothermia therapy was effective for patients with evacuated mass lesion.
