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院前创伤救护中主动升温在道路和空中救护转运中的效果-一项临床随机试验。

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial.

机构信息

Department of Surgery and Perioperative Sciences, Umeå University, Sweden.

出版信息

Scand J Trauma Resusc Emerg Med. 2011 Oct 21;19:59. doi: 10.1186/1757-7241-19-59.

Abstract

BACKGROUND

Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients.

METHODS

Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored.

RESULTS

Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05).

CONCLUSIONS

In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01400152.

摘要

背景

在院前创伤救护中,积极升温预防和治疗低体温是被推荐的,但在临床环境中,其有效性的科学证据很少。本研究的目的是评估在道路或空中救护车转运创伤患者时,额外的主动升温对患者的影响。

方法

将患者分为被动保暖(使用毯子)或被动保暖(使用毯子)加主动保暖干预(在上胸部使用大的化学热垫)。监测耳道温度、寒冷不适的主观感觉和生命体征。

结果

仅接受被动保暖的患者(n = 22)核心温度从 35.1°C(95%可信区间;34.7-35.5°C)升高到 36.0°C(95%可信区间;35.7-36.3°C)(p < 0.05),而接受额外主动保暖的患者(n = 26)从 35.6°C(95%可信区间;35.2-36.0°C)升高到 36.4°C(95%可信区间;36.1-36.7°C)(p < 0.05),两组间无显著差异。仅接受被动保暖的患者中,2/3 的患者寒冷不适减轻,而所有接受额外主动保暖的患者寒冷不适均减轻,差异具有统计学意义(p < 0.05)。接受额外主动保暖的患者心率和呼吸频率也有统计学意义的降低(p < 0.05)。

结论

在有颤抖能力的轻度低体温创伤患者中,充分的被动保暖是一种有效的治疗方法,可以建立缓慢复温率,并在院前转运过程中减少寒冷不适。然而,在上胸部使用化学热垫进行主动保暖会显著提高热舒适度,甚至可能降低冷应激反应。

试验注册

ClinicalTrials.gov:NCT01400152。

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