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  

Influencing factors and intervention effect of spontaneous hypothermia in severe trauma patients

作　　者：苏晓丽[1] 黄伟 赵江宁[1] 雒娜[1] SU Xiaoli;HUANG Wei;ZHAO Jiangning;LUO Na(Department of Emergency Surgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院急诊外科,陕西西安710068

出　　处：《陕西医学杂志》2022年第12期1568-1572,共5页Shaanxi Medical Journal

基　　金：陕西省卫生健康科研基金资助项目(2021D029)。

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。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 foRtrauma 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 numbeRtable method,and body nucleaRtemperatures before and 1,2 and 3 hours afteRintervention were compared between the two groups.Results:In univariate analysis,systolic blood pressure,acidosis,coagulopathy,Glasgow coma score,shivering,skin oRnail bed,trauma severity score,ambient temperature at the time of injury,amount of intravenous fluid(less than 21℃)oRblood(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℃)oRblood(about 4℃)were independent risk factors foRpost-traumatic spontaneous hypothermia(all P<0.05).Before the intervention,there was no significant difference in the body nucleaRtemperature between the conventional intervention group and the optimized intervention group(all P>0.05).At 1,2 and 3 hours afteRintervention,the body nucleaRtemperature of the optimized intervention group was significantly higheRthan that of

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 

分 类 号：R473.6[医药卫生—护理学]