Sran Bhupinder Jit K, McDonald Gerren K, Steinman Alan M, Gardiner Phillip F, Giesbrecht Gordon G
Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
Wilderness Environ Med. 2014 Mar;25(1):4-13. doi: 10.1016/j.wem.2013.10.005. Epub 2014 Jan 10.
The purpose of the study was to compare the effectiveness of head vs torso warming in rewarming mildly hypothermic, vigorously shivering subjects using a similar source of heat donation.
Six subjects (1 female) were cooled on 3 occasions in 8 ºC water for 60 minutes or to a core temperature of 35 ºC. They were then dried, insulated, and rewarmed by 1) shivering only; 2) charcoal heater applied to the head; or 3) charcoal heater applied to the torso. The order of rewarming methods followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured.
There were no significant differences in rewarming rate among the 3 conditions. Torso warming increased skin temperature and inhibited shivering heat production, thus providing similar net heat gain (268 ± 66 W) as did shivering only (355 ± 105 W). Head warming did not inhibit average shivering heat production (290 ± 72 W); it thus provided a greater net heat gain during 35 to 60 minutes of rewarming than did shivering only.
Head warming is as effective as torso warming for rewarming mildly hypothermic victims. Head warming may be the preferred method of rewarming in the field management of hypothermic patients if: 1) extreme conditions in which removal of the insulation and exposure of the torso to the cold is contraindicated; 2) excessive movement is contraindicated (eg, potential spinal injury or severe hypothermia that has a risk of ventricular fibrillation); or 3) if emergency personnel are working on the torso.
本研究旨在比较在使用类似热供应源对轻度低温、剧烈颤抖的受试者进行复温时，头部保暖与躯干保暖的效果。
6名受试者（1名女性）在8℃水中冷却3次，每次60分钟或直至核心体温降至35℃。然后将他们擦干、保温，并通过以下方式复温：1）仅靠颤抖；2）将炭火加热器置于头部；3）将炭火加热器置于躯干。复温方法的顺序采用平衡设计。测量食管温度、皮肤温度、心率、耗氧量和热通量。
三种情况下的复温速率无显著差异。躯干保暖可提高皮肤温度并抑制颤抖产热，因此净热量增加量与仅靠颤抖时相似（268±66瓦）。头部保暖并未抑制平均颤抖产热（290±72瓦）；因此在复温35至60分钟期间，其净热量增加量比仅靠颤抖时更大。
对于轻度低温患者的复温，头部保暖与躯干保暖效果相同。在低温患者的现场处理中，若出现以下情况，头部保暖可能是复温的首选方法：1）存在极端情况，禁忌去除保温措施并使躯干暴露于寒冷环境；2）禁忌过度活动（例如，存在潜在脊柱损伤或有室颤风险的严重低温）；或3）急救人员正在处理躯干情况。
