Aitken L M, Hendrikz J K, Dulhunty J M, Rudd M J
Griffith University, Nathan, QLD 4111, Australia.
Resuscitation. 2009 Feb;80(2):217-23. doi: 10.1016/j.resuscitation.2008.10.021. Epub 2008 Dec 6.
This study aimed to determine factors linked to hypothermia (<35 degrees C) in Queensland trauma patients. The relationship of hypothermia with mortality, admission to intensive care and hospital length of stay was also explored.
A retrospective analysis of data from the Queensland Trauma Registry was undertaken, and included all patients admitted to hospital for > or =24h during 2003 and 2004 with an injury severity score (ISS)>15. Demographic, injury, environmental, care and clinical status factors were considered.
A total of 2182 patients were included; 124 (5.7%) had hypothermia on admission to the definitive care hospital, while a further 156 (7.1%) developed hypothermia during hospitalisation. Factors associated with hypothermia on admission included winter, direct admission to a definitive care hospital, an ISS> or =40, a Glasgow Coma Scale of 3 or ventilated and sedated, and hypotension on admission. Hypothermia on admission to the definitive care hospital was an independent predictor of mortality (odds ratio [OR]=4.05; 95% confidence interval [CI] 2.26-7.24) and hospital length of stay (incidence rate ratio [IRR]=1.22; 95% CI 1.03-1.43). Hypothermia during definitive care hospitalisation was independently associated with mortality (OR=2.52; 95% CI 1.52-4.17), intensive care admission (OR=1.73; 95% CI 1.20-2.93) and hospital length of stay (IRR=1.18; 95% CI 1.02-1.36).
Trauma patients in a predominantly sub-tropical climate are at risk of accidental and endogenous hypothermia, with associated higher mortality and care requirements. Prevention of hypothermia is important for all severely injured patients.
本研究旨在确定与昆士兰创伤患者体温过低（<35摄氏度）相关的因素。同时探讨体温过低与死亡率、入住重症监护病房及住院时间的关系。
对昆士兰创伤登记处的数据进行回顾性分析，纳入2003年和2004年期间因伤入住医院超过或等于24小时且损伤严重度评分（ISS）>15的所有患者。考虑了人口统计学、损伤、环境、护理及临床状况等因素。
共纳入2182例患者；124例（5.7%）在入住确定性治疗医院时体温过低，另有156例（7.1%）在住院期间出现体温过低。入院时体温过低的相关因素包括冬季、直接入住确定性治疗医院、ISS>或=40、格拉斯哥昏迷量表评分为3或接受通气和镇静治疗以及入院时低血压。入住确定性治疗医院时体温过低是死亡率（比值比[OR]=4.05；95%置信区间[CI]2.26 - 7.24）和住院时间（发病率比[IRR]=1.22；95%CI 1.03 - 1.43）的独立预测因素。确定性治疗住院期间体温过低与死亡率（OR=2.52；95%CI 1.52 - 4.17）、入住重症监护病房（OR=1.73；95%CI 1.20 - 2.93）及住院时间（IRR=1.18；95%CI 1.02 - 1.36）独立相关。
在以亚热带气候为主的地区，创伤患者存在意外和内源性体温过低的风险，且伴有较高的死亡率和护理需求。预防体温过低对所有重伤患者都很重要。
