Arkley James, Taher Suhib, Dixon Ján, Dietz-Collin Gemma, Wales Stacey, Wilson Faye, Eardley William
Newcastle University, Newcastle Upon Tyne, United Kingdom.
James Cook University Hospital, Middlesbrough, United Kingdom.
Geriatr Orthop Surg Rehabil. 2020 Dec 29;11:2151459320949478. doi: 10.1177/2151459320949478. eCollection 2020.
Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population.
Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes.
Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming.
There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.
尽管采取了保暖措施，但髋部骨折患者在围手术期仍可能出现体温过低的情况。体温控制不佳与并发症增多和功能预后较差有关。有一般性证据表明维持正常体温有益，但在髋部骨折这一特定领域，相关证据却很稀少。我们对此类患者进行了首次全面综述。
大型研究揭示了体温过低对伤口感染、输血率、发病率和死亡率增加的巨大影响。由于很少有针对髋部骨折患者的研究，本综述旨在概述有关体温过低及其对预后影响的现有文献。
死亡率增加、再入院率和手术部位感染均与体温控制不佳有关。在老年体弱患者中，这种情况更为严重且更为常见。年龄增长和体重指数较低被认为是增加体温过低风险的人口统计学因素，尽管采用了主动保暖措施，但在现代临床实践中仍经常发现体温过低的情况。
在脆性骨折以及体温过低如何影响预后方面的研究存在空白。即使采用了主动保暖和使用棉被，术中意外体温过低仍经常发生。没有研究记录患者返回病房后术后的体温读数。而在这个时间点患者可能处于体温过低状态。需要针对该手术领域开展更多研究。
