目的探讨大脑半球大面积脑梗死患者血管内低温治疗期间,寒战出现规律与抗寒战措施,以保障血管内低温治疗的顺利实施。方法采用前瞻性队列研究,将22例接受血管内低温治疗并经抗寒战处理的患者,根据寒战程度,分为无寒战或轻度寒战(0～1级)组(5例)和中重度寒战(2～3级)组(17例)。分析寒战与低温的相关性、寒战与抗寒战药物的相关性、抗寒战药物不良反应以及寒战与预后的相关性。结果①22例患者中,低温全程伴有寒战19例(86.4%),其中轻度(1级)2例(10.5%)、中度(2级)12例(63.2%);重度(3级)5例(26.3%)。各低温阶段中,诱导低温期寒战发生率最高,为68.2%(15/22),0～1级寒战患者平均降温速度[(0.92±0.59)℃/h]快于2～3级寒战患者[(0.51±0.15)℃/h],但差异无统计学意义(t=1.941,P=0.090)。②应用哌替啶、咪达唑仑和肌松药的患者,寒战发生率分别为89.5%、83.3%和85.7%,差异无统计学意义;0～1级寒战组与2～3级寒战组比较,抗寒战药物负荷剂量和维持剂量差异均无统计学意义(P>0.05)。③抗寒战药物不良反应发生率依次为胃肠动力抑制(95.5%,21/22)、肝功能异常(77.3%,17/22)和循环抑制(40.9%,9/22)。④无寒战和轻度寒战患者与中重度寒战患者相比,不良预后差异无统计学意义(P>0.05)。结论低温过程中,诱导低温期间寒战发生率最高,并以中度寒战为主;中重度寒战可减慢诱导低温期间的降温速度,需采取更加积极的抗寒战措施;抗寒战药物不良反应出现率高,但可以控制,对预后影响不大。 Objective To investigate the regularity of chills and anti-chills measures during intra-vascular hypothermia in patients with cerebral infarction of large hemispheres in order to ensure the smooth implementation of intra-arterial hypothermia. Methods A prospective cohort study was conducted. Twenty-two patients who underwent intravascular hypothermia and were treated with anti-chills treatment were divided into chill-free or mild chills (grade 0 ~ 1) (n = 5) (2 to 3) group (17 cases). The correlation between chills and hypothermia, the correlation between chills and anti-chills, the adverse reactions to anti-chills drugs, and the correlation between chills and prognosis were analyzed. Results Among the 22 patients, there were 19 cases (86.4%) with chills in 2 patients (10.5%) in mild (grade 1) and 12 (63.2%) patients in moderate (grade 2) 5 cases (26.3%). The incidence of chills was the highest at 68.2% (15/22) in each stage of hypothermia, and the average cooling rate in patients with chills at 0 ~ 1 [(0.92 ± 0.59) ℃ / h] was faster than that of patients with cholera at level 2 ~ 3 (0.51 ± 0.15) ℃ / h], but the difference was not statistically significant (t = 1.941, P = 0.090). ② The incidence of chills was 89.5%, 83.3% and 85.7% in patients receiving pethidine, midazolam and muscle relaxant, respectively, with no significant difference between the two groups. Chills 0 to 1 and chills 2 to 3 There was no significant difference in loading dose and maintenance dose of anti-chills drug (P> 0.05). ③ The incidences of anti-chills drugs were gastrointestinal motility inhibition (95.5%, 21/22), abnormal liver function (77.3%, 17/22) and circulatory depression (40.9%, 9/22) in turn. ④ There was no significant difference in adverse prognosis among patients without chills and mild chills as compared with those with moderate-severe chills (P> 0.05). Conclusions The incidence of chills was the highest during low temperature induction and was moderately chilling. Moderate and severe chills could slow down the cooling rate during induction of low temperature, and more aggressive anti-chills measures should be taken. The incidence of anti-chills drug adverse reactions High, but can be controlled, little effect on prognosis.