Hayward J S, Eckerson J D, Kemna D
Resuscitation. 1984 Feb;11(1-2):21-33. doi: 10.1016/0300-9572(84)90031-5.
The interrelations among core temperatures (cardiac, esophageal, tympanic, rectal), skin temperature, and cardiovascular function (cardiac output, arterial pressure, heart rate, total peripheral resistance) were studied in a conscious subject during entry into mild hypothermia through cold water (10 degrees C) immersion, and during rewarming by three basic procedures: peripheral heat donation (bath); core heat donation (inhalation); and no exogenous heat (spontaneous). Swan-Ganz catheterization of the heart enabled measurement of cardiac temperature as well as cardiac output by the thermal dilution method. During cooling, all sites of core temperature measurement showed similar rates of entry into hypothermia. However, during the rewarming procedures, divergent patterns of temperature change among the four sites occurred. Rectal and tympanic temperatures were not representative of cardiac temperature, but esophageal temperature was, and is therefore most suitable as a criterion for experimental evaluation of the thermal benefit of various core rewarming techniques. During the first 30 min of rewarming, rates of increase in cardiac temperature for bath, inhalation, and spontaneous procedures varied according to the proportions 4:2:1, respectively. No afterdrop of cardiac temperature occurred with the inhalation or spontaneous procedures, but an afterdrop at this site did occur during the first 15 min of bath rewarming as soon as skin temperature was greater than 30 degrees C. This afterdrop coincided with cardiovascular changes including abrupt decreases in arterial pressure and total peripheral resistance, along with increases in heart rate and cardiac output. Such evidence of increased peripheral circulation was not observed with the inhalation and spontaneous methods. The findings relate to experimental evaluation of rewarming techniques and principles for resuscitation of hypothermia victims, especially in the first-aid situation.
在一名清醒受试者中，研究了通过冷水（10摄氏度）浸泡进入轻度低温期间以及通过三种基本复温程序复温期间，核心温度（心脏、食管、鼓膜、直肠）、皮肤温度和心血管功能（心输出量、动脉压、心率、总外周阻力）之间的相互关系。这三种复温程序分别为：外周热传递（盆浴）；核心热传递（吸入）；无外源性热（自然复温）。通过 Swan - Ganz 心脏导管插入术能够测量心脏温度以及采用热稀释法测量心输出量。在降温过程中，所有核心温度测量部位进入低温的速率相似。然而，在复温过程中，这四个部位出现了不同的温度变化模式。直肠温度和鼓膜温度不能代表心脏温度，但食管温度可以，因此最适合作为各种核心复温技术热效益实验评估的标准。在复温的前30分钟内，盆浴、吸入和自然复温程序中心脏温度升高的速率分别按照4:2:1的比例变化。吸入或自然复温程序未出现心脏温度的体温后降，但在盆浴复温的前15分钟内，一旦皮肤温度高于30摄氏度，该部位就会出现体温后降。这种体温后降与心血管变化同时出现，包括动脉压和总外周阻力突然下降，以及心率和心输出量增加。吸入和自然复温方法未观察到这种外周循环增加的证据。这些发现与复温技术的实验评估以及低温受害者复苏的原则相关，尤其是在急救情况下。
