| Objective : The purpose of this study was to determine the relationship between brain and rectal temperature in patients in acute phase of severe traumatic brain injury (STBI) during the treatment of mild hypothermia, and to explore a simple , safe and reliable way to evaluate BT with RT more accurately.Methods : 52 patients suffering from STBI, with a GCS of 8 or less were hospitalized within 2~21hours(6.0 4.5h average), and were continuously measured of BT and RT forl3~110h(58.1 25.7h average) during the treatment of mild hypothermia. A flexible K-type thermocouple (Licox- II CMP, GMS Co Ltd, Germany) was used for continuous monitoring of brain temperature (BT) , located at the non-injured frontal white matter, 27-36 mm below the dura . Rectal temperature (RT) was continuously measured with a commercially available temperature probe (Cincinnati Sub-Zero,Blanketrol-II,American), which placed 10 cm into the rectum. Results : (1)In 47 patients(90.4%) in acute phase of STBI, RT were higher than 36 (RT>36 ,normothermic and hyperthermic group); only in 5 patients(9.6%) RT were lower than 36 (RT<36 .spontaneous hypothermic group). There were significant differences between BT and RT in both groups. (1)In normothermic and hyperthermic group, BT was higher than RT(0.50 0.29) ,both of them decreased during the treatment of mild hypothermia. A good correlation between BT and RT could be seen (r=0.946, P<0.001), Y(BT)=0.966X(RT)+1.700; in spontaneous hypothermic group, BT was lower than RT(-0.65 0.39) , a significant correlation between BT and RT also could be seen (r=0.931, P<0.001), Y(BT)=1.122X(RT)-4.862. (2)The differences between BT and RT ( | TB-R | ) in spontaneous hypothermic group were significantly larger than that in normothermic and hyperthermic group (P<0.01). (2) In normothermic and hyperthermic group, TB-R were evaluated in there temperature ranges: RT<36 , 36 RT 38 and RT>38 . TB-R was significantly greater in the RT<36癈 and RT>38 ranges than that in the 36 RT 38 range (P<0.01). RT<36 , BT was higher than RT(0.56 0.29) ; 36 RT 38 , BT was higher than RT(0.38 0.25) ; RT>38 , BT was higher than RT(0.59 0.28) . (3)The outcome of all patients was studied 1 month after injury using the Glasgow Outcome Score (GOS-1). Out of 5 patients in spontaneous hypothermic group , 3 were dead within 48h after injury, 2 were in vegetative state; out of 47 patients in normothermic and hyperthermic group, 18 with good recovery , 11 with moderate disability, 8 with severe disability, 4 in vegetative state, 6 were dead. Spontaneous hypothermic group was significantlyaccompanied by poor outcome (P<0.05).Conclusion : (l)It is not actually correct to regard RT as BT in patients in acute phase of STBI . (2)In patients in acute phase of STBI, BT was higher than RT in norrnothermic and hyperthermic group; and BT was much lower than RT in spontaneous hypothermic group. (3)There was a good positive correlation between BT and RT in all patients, and it is a reliable way to evaluate BT with RT correctly according to the corresponding regression equation. It suggests that the measurement of RT my be an alternative way for monitoring of BT to be used in clinical work, because of the simplicity, safety, non-injury, and economization of the RT measurement. (4) The differences between BT and RT are greater in abnormal temperature ranges (RT<36 and RT>38 ). (5)The patients in spontaneous hypothermic state after STBI ,with a large difference between BT and RT , to be accompanied by poor outcome. It is implied that there is a lack of temperature regulation , and irreversible neuronal damage in these patients. Moreover, it suggests that the measurement of RT in patients in acute phase of STBI may be as one of indexes for prognosis evaluation.
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