Pirnes Jari, Ala-Kokko Tero
Division of Intensive Care Medicine, and Medical Research Center Oulu, Department of Anaesthesiology, Oulu University Hospital and Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Box 21, OUH, 90029, Oulu, Finland.
Intern Emerg Med. 2017 Dec;12(8):1225-1233. doi: 10.1007/s11739-016-1547-y. Epub 2016 Sep 27.
Accidental hypothermia has a low incidence, but is associated with a high mortality rate. Knowledge about concomitant factors, complications, and length of hospital stay is limited. A retrospective cohort study on patients with accidental hypothermia admitted to Oulu University Hospital in Finland, over a 5-year period. Patients were categorized as short-stay patients (7 days or less) and long-stay patients (more than 7 days) according to their length of stay in hospital. From a total of 105 patients, 67 patients were included in the analyses. Alcohol abuse was the most common concomitant factor (54 %). Median length of hospital stay was 4 days, and 16 patients (24 %) stayed in hospital over 7 days (median 15 days). Thirty-day mortality was low (14/105, 13 %). Patients with long-term hospitalization had a lower initial temperature (28.4 versus 31.2 °C, p = 0.011), a lower level of consciousness (GCS score 8.4 versus 12.8, p = 0.003), more severe acidosis (pH 7.08 versus 7.28, p = 0.005, and lactate 7.2 versus 3.9, p = 0.043), and a lower level of platelets (183 versus 242, p = 0.041) on admission compared with short-stay patients. Thirty-six patients (54 %) had at least one complication, and this prolonged median hospital treatment for 2.5 days (p < 0.001). Alcohol is the most common concomitant factor and every fourth patient spends more than 7 days in hospital. Long-term hospitalization is related to a lower core temperature, lower consciousness, more severe lactic acidosis, lower platelet level and infections, rhabdomyolysis, and renal failure.
意外低温的发病率较低，但死亡率较高。关于伴随因素、并发症及住院时间的相关知识有限。对芬兰奥卢大学医院收治的意外低温患者进行了一项为期5年的回顾性队列研究。根据患者的住院时间，将其分为短期住院患者（7天及以内）和长期住院患者（超过7天）。在总共105例患者中，67例患者纳入分析。酗酒是最常见的伴随因素（54%）。中位住院时间为4天，16例患者（24%）住院超过7天（中位时间为15天）。30天死亡率较低（14/105，13%）。长期住院患者入院时初始体温较低（28.4对31.2℃，p = 0.011）、意识水平较低（格拉斯哥昏迷评分8.4对12.8，p = 0.003）、酸中毒更严重（pH值7.08对7.28，p = 0.005，乳酸7.2对3.9，p = 0.043），且血小板水平较低（183对242，p = 0.041），与短期住院患者相比。36例患者（54%）至少有一项并发症，这使中位住院治疗时间延长了两天半（p < 0.001）。酗酒是最常见的伴随因素，每四位患者中有一位住院超过7天。长期住院与较低的核心体温、较低的意识、更严重的乳酸酸中毒、较低的血小板水平以及感染、横纹肌溶解和肾衰竭有关。
