The Effect Of Body Temperature Management On The Prognosis, Caspase-3and Caspase-9(in Cerebrospinal Fluid) Of Patients With STBI

Part1:The study on the evaluation of fever severity in patients with severe traumatic brain injuriesObjective:By comparing the differences in the average body temperature and fever intensity among different fever severities occurring in patients with severe traumatic brain injuries (sTBI), the study aims to explore the clinical significance of fever intensity in the evaluation of fever severity.Method:The retrospective analysis was conducted on the clinical information of155cases of patients with sTBI who were admitted in our hospital between January2009and December2010. Based on recorded original body temperature, the average body temperature and the fever intensity of each patient on day1,3,5, and7were calculated according to the average body temperature equation and the fever intensity equation, respectively. With reference to their1-2years post-injury Glasgow Outcome Scale (GOS) scores, the patients were divided into two groups, i.e. those with a GOS score of1-3were classified as the poor prognosis group; while those with a GOS score of4-5were classified as the excellent prognosis group. The differences in the average temperature and the fever intensity between the two groups were compared, respectively. Result:1. The comparison of the average body temperature between the poor prognosis group and the excellent prognosis group:the difference in the average body temperatures at various time intervals (day1,3,5and7) between the two group was insignificant (P>0.05).2. The comparison of the fever intensity between the poor prognosis group and the excellent prognosis group:the difference in the fever intensity at various time intervals (day1,3,5and7) between the two group was significant (P<0.05).3. The comparison of the original body temperature:when the average original body temperatures had identical or close values, the proportion of fever (>37.3℃) symptoms in the poor prognosis group was higher than that in the excellent prognosis group.Conclusion:1. The result of fever severity evaluation could affect the assessment of the clinical research outcome for patients with sTBI.2. Comparing to the average body temperature, the fever intensity appeared to reflect the degree of fever severity in patients with sTBI better. Part2:The effect of body temperature management on the prognosis, caspase-3and caspase-9(in cerebrospinal fluid) of patients with sTBIObjective:By maintaining the body temperature of the patients with sTBI consistently at36-37℃during7-day acute stage, the study aims to investigate the effects of body temperature management on the prognosis, caspase-3and caspase-9(in cerebro-spinal fluid) of patient with sTBI.Method:in this study,42cases of patients with sTBI eligible for the study (GCS score≤8) were randomly divided into two groups, i.e. the testing group and the control group. In the testing group, patients were treated with mild hypothermia therapy during7-day acute stage for maintaining the rectal temperature consistently at36-37℃; while the patients in the control group did not receive any body temperature management. All the patients in both groups have underwent lateral ventricle puncture, to collect the cerebrospinal fluid (CSF) samples on day1,3,5and7after hospitalization. The concentrations of caspase-3and caspase-9in these samples were determined. By conducting the follow-ups for these patients,3-6months post-injury GOS scores were recorded, so as to compare the difference in the concentrations of CSF caspase-3and CSF caspase-9, as well as the difference in the prognosis, between the two groups. Result:1. The comparison of prognosis between the testing group and the control group:in the testing group, the incidence of poor prognosis and excellent prognosis were31.8%and68.2%, respectively; while those in the control group were65%and35%, respectively. The difference in the prognosis between the two groups were significant, P<0.05.2. The comparison of caspase-3concentration in CSF between he testing group and the control group:the difference in the concentration between the two groups on day1was insignificant, P>0.05; however, on day3,5and7, the concentrations in the testing group were all lower than those in the control group, P<0.05, the differences between the two groups were statistically significant.3. The comparison of caspase-9concentration in CSF between he testing group and the control group:he difference in the concentration between the two groups on day1was insignificant, P>0.05; however, on day3,5and7, the concentrations in the testing group were all lower than those in the control group, P<0.05, the differences between the two groups were statistically significant.Conclusion:1. The7days post-injury body temperature management (maintained consistently at36-37℃) could effectively reduce the incidence of poor prognosis for the patients with severe STBI, i.e. improve the prognosis of these patients.2. The body temperature management (maintained consistently at36-37℃) could reduce the concentrations of caspase-3and caspase-9in CSF of the patients with severe TBI, and thus reducing the occurrence of neuron apoptosis in patients with severe TBI.