Haverkamp Frederike J C, Giesbrecht Gordon G, Tan Edward C T H
Researcher, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Professor, Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
Injury. 2018 Feb;49(2):149-164. doi: 10.1016/j.injury.2017.11.001. Epub 2017 Nov 4.
Accidental hypothermia concerns a body core temperature of less than 35°C without a primary defect in the thermoregulatory system. It is a serious threat to prehospital patients and especially injured patients, since it can induce a vicious cycle of the synergistic effects of hypothermia, acidosis and coagulopathy; referred to as the trauma triad of death. To prevent or manage deterioration of a cold patient, treatment of hypothermia should ideally begin prehospital. Little effort has been made to integrate existent literature about prehospital temperature management. The aim of this study is to provide an up-to-date systematic overview of the currently available treatment modalities and their effectiveness for prehospital hypothermia management.
Databases PubMed, EMbase and MEDLINE were searched using the terms: "hypothermia", "accidental hypothermia", "Emergency Medical Services" and "prehospital". Articles with publications dates up to October 2017 were included and selected by the authors based on relevance.
The literature search produced 903 articles, out of which 51 focused on passive insulation and/or active heating. The most effective insulation systems combined insulation with a vapor barrier. Active external rewarming interventions include chemical, electrical and charcoal-burning heat packs; chemical or electrical heated blankets; and forced air warming. Mildly hypothermic patients, with significant endogenous heat production from shivering, will likely be able to rewarm themselves with only insulation and a vapor barrier, although active warming will still provide comfort and an energy-saving benefit. For colder, non-shivering patients, the addition of active warming is indicated as a non-shivering patient will not rewarm spontaneously. All intravenous fluids must be reliably warmed before infusion.
Although it is now accepted that prehospital warming is safe and advantageous, especially for a non-shivering hypothermic patient, this review reveals that no insulation/heating combinations stand significantly above all the others. However, modern designs of hypothermia wraps have shown promise and battery-powered inline fluid warmers are practical devices to warm intravenous fluids prior to infusion. Future research in this field is necessary to assess the effectiveness expressed in patient outcomes.
意外低温是指体温调节系统无原发性缺陷时，人体核心温度低于35°C。它对院前患者，尤其是受伤患者构成严重威胁，因为它可引发低温、酸中毒和凝血功能障碍协同作用的恶性循环，即所谓的死亡三联征。为防止或控制体温过低患者的病情恶化，理想情况下，低温治疗应在院前就开始。在整合现有关于院前体温管理的文献方面，所做的工作很少。本研究的目的是对目前可用的治疗方式及其在院前低温管理中的有效性提供最新的系统综述。
使用 “低温”“意外低温”“紧急医疗服务” 和 “院前” 等术语检索了数据库PubMed、EMbase和MEDLINE。纳入了截至2017年10月发表的文章，并由作者根据相关性进行筛选。
文献检索共产生903篇文章，其中51篇关注被动保暖和/或主动加热。最有效的保暖系统是将隔热与防潮层相结合。主动体外复温干预措施包括化学、电和燃烧木炭的热敷袋；化学或电加热毯；以及强制空气升温。轻度低温患者因寒战会产生大量内源性热量，仅通过保暖和防潮层可能就能自行复温，不过主动升温仍能带来舒适感并节省能量。对于体温更低、不发生寒战的患者，则需要进行主动升温，因为不发生寒战的患者不会自发复温。所有静脉输液在输注前都必须可靠地加温。
尽管现在人们已经认识到院前升温是安全且有益的，特别是对于不发生寒战的低温患者，但本综述表明，没有哪种隔热/加热组合明显优于其他组合。然而，现代低温包裹设计已显示出前景，电池供电的在线液体加温器是在输注前加温静脉输液的实用设备。该领域未来有必要开展研究，以评估对患者预后的有效性。
