58例体外心肺复苏患者目标体温管理临床观察  

Clinical observation of target temperature management in 58 patients with extracorporeal cardiopulmonary resuscitation

作　　者：高永霞 陈旭锋 梅勇 黄红娟 何敏 黄夕华 郭媛 蔡金霞 Gao Yongxia;Chen Xufeng;Mei Yong;Huang Hongjuan;He Min;Huang Xihua;Guo Yuan;Cai Jinxia(Department of Emergency Intensive Care Unit of Jiangsu Provincial People's Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院、江苏省人民医院急诊医学中心,江苏南京210029

出　　处：《中国急救医学》2023年第8期620-624,共5页Chinese Journal of Critical Care Medicine

基　　金：江苏省人民医院2020年度“临床能力提升工程”(JSPH-NB-2020-10);江苏省财政支持临床重点专科项目[苏财政(2020)155号];江苏省专科能力建设项目[苏财政(2021)79号]。

摘　　要：目的观察体外心肺复苏患者(extracorporeal cardiopulmonary resuscitation,ECPR)目标体温管理(target temperature management,TTM)不同实施方法的临床效果。方法回顾性纳入2020年1月至2021年12月江苏省人民医院急诊监护病房收治转机时间超过24 h的ECPR患者,根据ECPR患者TTM实施方法分为观察组及对照组,观察组采用医用物理升降温仪实施TTM,对照组采用医用水循环升降温毯实施TTM,统计患者的基本资料,分别比较两组患者的基础体温、目标体温,体温诱导时间、临床操作用时、日体温最大波动、患者预后及降温并发症。结果共纳入58例ECPR患者,总体出院存活21例(36.2%),其中对照组8例(28.6%),观察组13例(43.3%)。两组患者基础体温、目标体温、神经功能指标、降温并发症(下肢缺血、血流感染)比较差异均无统计学意义(P>0.05),体温诱导时间(h:6.04±0.69 vs.2.22±0.44)、临床操作用时(min:9.52±0.40 vs.3.54±0.34)、日体温最大波动(℃:0.68±0.11 vs.0.34±0.09)、降温并发症[寒颤(25.0%vs.3.3%)、高血糖(32.1%vs.6.7%)、腹泻(39.3%vs.6.7%)]比较差异均有统计学意义(P<0.05)。结论医用物理升降温仪实施TTM临床操作简便迅速,降温速度快,临床并发症少,更有益于ECPR患者TTM的实施,值得临床推广应用。Objective To observe the clinical effects of different implementation methods of target temperature management(TTM)in the patients with extracorporeal cardiopulmonary resuscitation(ECPR).Methods ECPR patients with a transfer time of more than 24 h admitted to the emergency intensive care unit of Jiangsu Provincial People's Hospital from January 2020 to December 2021 were retrospectively enrolled.According to the implementation method of TTM for ECPR patients,they were divided into the observation group and the control group.The patients in the observation group were treated with hypo-/hyperthermia units for TTM,while the patients in the control group were treated with medical water circulation cooling blanket for TTM.The basic data of the patients were collected,and the basal body temperature,target body temperature,temperature induction time,clinical operation time,maximum fluctuation of daily body temperature,prognosis and cooling complications of the two groups were compared.Results A total of 58 patients with ECPR were included,21 patients(36.2%)survived including 8 patients(28.6%)in the control group and 13 patients(43.3%)in the observation group.There were no significant differences in basal body temperature,target body temperature,neurological index,hypothermia complications(lower limb ischemia and bloodstream infection)between the two groups(P>0.05).Temperature induction time(h:6.04±0.69 vs.2.22±0.44),clinical operation time(min:9.52±0.40 vs.3.54±0.34),maximum fluctuation of daily body temperature(℃:0.68±0.11 vs.0.34±0.09),hypothermia complications[shivering(25%vs.3.3%),hyperglycemia(32.1%vs.6.7%)and diarrhea(39.3%vs.6.7%)]were statistically significant(P<0.05).Conclusions Hypo-/hyperthermia units to implement TTM has simple and rapid clinical operation,fast cooling speed and fewer clinical complications,which is more beneficial to the implementation of TTM in ECPR patients,and is worthy of clinical promotion and application.

关 键 词：体外心肺复苏 呼吸心脏骤停 目标体温管理 医用物理升降温仪 

分 类 号：R654.1[医药卫生—外科学]