[1]苏晓丽,黄 伟,赵江宁,等.严重创伤患者自发性低体温发生影响因素及干预效果研究[J].陕西医学杂志,2022,51(12):1568-1572.[doi:DOI:10.3969/j.issn.1000-7377.2022.12.024]
　SU Xiaoli,HUANG Wei,ZHAO Jiangning,et al.Influencing factors and intervention effect of spontaneous hypothermia in severe trauma patients[J].,2022,51(12):1568-1572.[doi:DOI:10.3969/j.issn.1000-7377.2022.12.024]
点击复制

严重创伤患者自发性低体温发生影响因素及干预效果研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年12期
页码:
1568-1572
栏目:
临床研究
出版日期:
2022-12-05

文章信息/Info

Title:
Influencing factors and intervention effect of spontaneous hypothermia in severe trauma patients
作者:
苏晓丽; 黄 伟; 赵江宁; 雒 娜
(陕西省人民医院急诊外科,陕西 西安 710068)
Author(s):
SU Xiaoli; HUANG Wei; ZHAO Jiangning; LUO Na
(Department of Emergency Surgery,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
关键词:
严重创伤;  自发性低体温;  影响因素;  体核温度;  干预效果
Keywords:
Severe trauma;  Spontaneous hypothermia;  Influencing factors;  Body nuclear temperature;  Intervention effect
分类号:
R 473.6
DOI:
DOI:10.3969/j.issn.1000-7377.2022.12.024
文献标志码:
A
摘要:
目的:探讨严重创伤患者自发性低体温发生影响因素及干预效果。方法:选取严重创伤患者316例为研究对象,其中出现低体温患者127例(低体温组),未出现低体温患者189例(非低体温组)。所有患者均接受创伤患者低体温风险评估量表评估。采用单因素分析创伤后患者自发性低体温风险评估量表中相关指标与创伤后低体温发生的相关性。采用多因素Logistic回归分析创伤后患者自发性低体温发生的危险因素。采用随机数字表法将低体温组患者分为常规干预组(63例)和优化干预组(64例),比较两组干预前和干预后1、2、3 h的体核温度。结果:单因素分析结果显示,收缩压、酸中毒、凝血功能障碍、格拉斯哥昏迷评分、寒战、皮肤或甲床、创伤严重程度评分、受伤时环境温度、静脉输入液体(<21 ℃)或血液(4 ℃左右)量及自创伤起至医院的时间均与创伤后自发性低体温发生相关(均P<0.05)。Logistic回归分析结果显示,收缩压、酸中毒、凝血功能障碍、格拉斯哥昏迷评分、创伤严重程度评分、受伤时环境温度及静脉输入液体(<21 ℃)或血液(4 ℃左右)量是创伤后低体温发生的独立危险因素(均P<0.05)。干预前,常规干预组和优化干预组患者体核温度比较差异无统计学意义(均P>0.05); 干预后1、2、3 h,优化干预组患者的体核温度明显高于常规干预组(均P<0.05)。结论:严重创伤患者自发性低体温发生受多种因素影响,应对患者创伤程度、救治措施等因素进行综合评估,早期预防自发性低体温并积极进行复温。
Abstract:
Objective:To explore the influencing factors of spontaneous hypothermia in patients with severe trauma and the effect of intervention.Methods:A total of 316 patients with severe trauma were selected as the research objects,including 127 patients with hypothermia(hypothermia group)and 189 patients without hypothermia(non-hypothermia group).All patients were assessed with a hypothermia risk assessment scale for trauma patients.Univariate analysis was used to analyze the correlation between the relevant indicators in risk assessment scale of spontaneous hypothermia and the occurrence of post-traumatic spontaneous hypothermia.Multivariate Logistic regression was used to analyze the risk factors of spontaneous hypothermia in post-traumatic patients.Patients in the hypothermia group were divided into conventional intervention group(63 cases)and optimized intervention group(64 cases)by random number table method,and body nuclear temperatures before and 1,2 and 3 hours after intervention were compared between the two groups.Results:In univariate analysis,systolic blood pressure,acidosis,coagulopathy,Glasgow coma score,shivering,skin or nail bed,trauma severity score,ambient temperature at the time of injury,amount of intravenous fluid(less than 21 ℃)or blood(about 4 ℃),and time from trauma to hospital were all correlated with the occurrence of post-traumatic spontaneous hypothermia(all P<0.05).Logistic regression analysis showed that systolic blood pressure,acidosis,coagulation dysfunction,Glasgow coma score,trauma severity score,ambient temperature at the time of injury and intravenous fluid(less than 21 ℃)or blood(about 4 ℃)were independent risk factors for post-traumatic spontaneous hypothermia(all P<0.05).Before the intervention,there was no significant difference in the body nuclear temperature between the conventional intervention group and the optimized intervention group(all P>0.05).At 1,2 and 3 hours after intervention,the body nuclear temperature of the optimized intervention group was significantly higher than that of the conventional intervention group(all P<0.05).Conclusion:The occurrence of spontaneous hypothermia in patients with severe trauma is affected by many factors.Comprehensive assessment should be carried out on the degree of trauma,treatment measures and other factors,and early prevention of spontaneous hypothermia and active rewarming should be carried out.

参考文献/References:

[1] 李 雯,蒋 娟,段晶晶,等.急诊创伤后发生自发性低体温的影响因素及其相关性[J].国际护理学杂志,2020,39(4):599-602.
[2] 顾 微.急诊创伤危重患者采取全程保温护理后的干预效果及低体温发生率研究[J].中国药物与临床,2021,21(2):361-363.
[3] Zhou LH,Hong JF,Qin RM,et al.Post-traumatic growth and its influencing factors among Chinese women diagnosed with gynecological cancer:A cross-sectional study[J].European Journal of Oncology Nursing,2021,51(1):1019-1026.
[4] 赵丽燕,刘雄涛,倪秀梅,等.综合保温法用于直肠癌手术58例[J].陕西医学杂志,2012,41(7):912-913.
[5] Rossaint R,Bouillon B,Cerny V,et al.The European guideline on management of major bleeding and coagulopathy following trauma:Fourth edition[J].Critical Care,2016,20:100.
[6] 颜雷雷,廖德珺,金倩倩,等.系统分级复温措施对急诊创伤手术患者体温及预后的影响[J].中华危重病急救医学,2021,33(12):1459-1465.
[7] 曹媛媛,陈 鑫,李 筝.战创伤低体温的预防与处理研究进展[J].医学研究生学报,2022,35(1):109-112.
[8] 涂加园,刘 云,孙 琳,等.创伤患者低体温风险评估量表的编制及信效度检验[J].中华护理杂志,2020,55(12):1813-1818.
[9] Eidstuen SC,Uleberg O,Vangberg G,et al.When do trauma patients lose temperature? A prospective observational study[J].Acta Anaesthesiologica Scandinavica,2018,62(3):384-393.
[10] Harten-Ash LV,Hudson A.Hypothermia among trauma patients in the Emergency Department(ED):A review of documentation and management[J].Scandinavian Journal of Trauma Resuscitation and Emergency Medicine,2014,22(1):785-792.
[11] 邓 妍,黄珍玲,张莉莉,等.Glasgow评分在急性创伤患者低体温发生中的预测作用[J].临床与病理杂志,2019,39(12):2787-2791.
[12] Weuster M,Brück A,Lippross S,et al.Epidemiology of accidental hypothermia in polytrauma patients:An analysis of 15230 patients of the trauma register DGU[J].Journal of Trauma and Acute Care Surgery,2016,81(5):905-912.
[13] 张董瑜,冯 琪,邵长会,等.围术期全程闭环体温管理系统预防老年股骨颈骨折患者低体温的效果[J].中华创伤杂志,2021,37(12):1119-1125.
[14] Aitken LM,Hendrikz JK,Dulhunty JM,et al.Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate[J].Resuscitation,2009,80(2):217-223.
[15] 熊 璨,高兴莲,向御婷,等.成人手术患者术中低体温影响因素的Meta分析[J].护理学报,2018,25(2):48-53.
[16] 王 君,白 颖,周 宁.创伤性凝血病发生的危险因素及其对多发创伤患者预后的影响[J].临床急诊杂志,2018,19(2):113-116.
[17] 王 芳,王 秋.围手术期保温干预对急性创伤患者低体温发生率及预后的影响[J].武警后勤学院学报:医学版,2019,28(7):38-41.
[18] 马 飞.ISS评分对严重创伤患者病情及预后的预测价值[J].海南医学,2018,29(6):789-791.
[19] Morris NB,Jay O.Staying warm in the cold with a hot drink:The role of visceral thermoreceptors[J].Temperature,2017,4(2):123-125.
[20] 朱芳芸,张霞婧,朱明霞,等.保温措施对全麻肾移植患者围术期体温和苏醒的影响[J].陕西医学杂志,2020,49(2):190-192,196.

备注/Memo

备注/Memo:
基金项目:陕西省卫生健康科研基金资助项目(2021D029)
更新日期/Last Update: 2022-12-05