重症頭部外傷に対する積極的体温管理の現状と有用性：P2015のデータを用いて

抄録

Objective: We investigated recent situation of targeted temperature management (TTM) and assessed usefulness of TTM of severe TBI from the data of the Project 2015 (P2015) in the Japan Neurotrauma Data Bank.

Methods: This is a cohort observational study of a nationwide prospective registry between April 2015 and March 2017. Among registered patients, those with a Glasgow Coma Scale (GCS) score of 9 or more and a GCS score of 3 with bilateral nonreactive pupils, and those with only epidural hematoma in CT scan, and not underwent radical treatment were excluded. First, the implementation rate of TTM in P2015 was compared to that of P2009. Second, the patients were divided into the two groups: the TTM group and the control group not underwent TTM. Using propen­sity score matching, the unfavorable outcome and mortality of the TTM group were compared to the control group.

Results: Of 1,345 registered patients, 552 adult severe TBI patients were included. The implementation rate of hypothermia in P2015 was significantly lower than that in P2009 (3% vs. 13%); however, the implementation rate of normothermia in P2015 was higher than that in P2009 (34% vs. 29%). In the propensity score matching analysis, 100 patients of the TTM group were matched to 100 patients of the control group, and there was no significant difference of unfavorable outcome (57% vs. 63%, p=0.39) and mortality (34% vs. 39%, p=0.46) between the TTM group and the control group. In the subgroup analyses, the TTM group demonstrated a significant reduction of unfavorable out­come compared with the control group in patients with surgical removal for intracranial hematomas (65.5% vs. 83.6%, p=0.03).

Conclusion: Among severe TBI patients with surgical removal of for intracranial hematomas, TTM improved neurological outcome at 6 months. TTM including intensive normothermia is consid­ered as a treatment option in neurointensive care for severe TBI.