Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
Resuscitation. 2011 Mar;82(3):300-6. doi: 10.1016/j.resuscitation.2010.10.016. Epub 2010 Nov 12.
Serious sequelae have been associated with injured patients who are hypothermic (<35°C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality.
Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors.
Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic.
Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and winter time: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge.
Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 °C.
体温低于 35°C（<35°C）的受伤患者可能出现严重的并发症，包括凝血功能障碍、酸中毒、心肌收缩力下降和死亡率增加。
确定重大创伤患者意外低体温的发生率，并确定其病因。
对 2008 年 1 月至 12 月期间在成人重大创伤中心就诊的 732 例重大创伤患者的病历进行前瞻性识别和随后的回顾性分析。使用逻辑回归进行多变量分析。对单变量分析中有统计学意义和临床意义的变量进行多变量模型分析，以评估低体温和死亡的决定因素。使用 Hosmer-Lemeshow 统计量来确定拟合优度。
总体死亡率为 9.15%。低体温的发生率为 13.25%。低体温患者的死亡率为 29.9%，死亡风险增加三倍：OR（95%CI）为 3.44（1.48-7.99），P=0.04。低体温的独立决定因素为院前插管：OR（95%CI）为 5.18（2.77-9.71），P<0.001，损伤严重程度评分（ISS）：1.04（1.01-1.06），P=0.01，入院收缩压（ASBP）<100mmHg：3.04（1.24-7.44），P=0.02，冬季时间：1.84（1.06-3.21），P=0.03。在 87 例体温记录在急诊科的低体温患者中，77 例（88.51%）患者的体温高于记录的到达体温。有 4 例（4.60%）患者的体温记录没有变化，而 6 例（6.90%）患者在急诊科出院时体温更低。
意外低体温的严重受伤患者的死亡率独立于已测量的危险因素。对于多发伤患者，急救人员、护士和医生需要协调努力，尽早解决低体温问题，使体温>35°C。
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