恩桑比亚圣弗朗西斯医院重大创伤患者体温过低及其对复苏反应的相关因素:一项前瞻性观察研究

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Patrick Akena, Ronald Kiweewa, Ronald Olum, Andrew Basenero, Rebecca Nabulya, Assumpta Nabawanuka, Didace Mugisa
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引用次数: 0

摘要

背景:低体温,定义为核心体温低于35°C,是创伤患者中常见但未被重视的并发症。它导致凝血功能障碍、免疫反应受损和更高的发病率,在严重受伤的创伤患者中,其发病后死亡率上升25%。本研究旨在确定与Nsambya圣弗朗西斯医院重大创伤患者的低温相关的因素及其对复苏的反应。方法:这是一项前瞻性观察研究,研究对象是2022年11月至2023年4月期间在恩桑比亚圣弗朗西斯医院急诊科收治的99名成人严重创伤患者。患者在到达后连续入组,使用布朗红外线鼓室温度计测量他们的体温。预先测试的数据抽象工具收集了人口统计学、损伤特征和入院前事件的信息。主要结局是体温过低的发生率。采用STATA Version 17.0进行数据分析,采用多变量logistic回归分析确定与低温相关的因素。结果:本研究共纳入99例外伤患者,其中39例(39%)到达医院时体温过低。男性居多,26 ~ 45岁78例(78.8%),27 ~ 52岁49例(49.5%)。钝性伤是最常见的损伤机制(86.9%),其次是穿透伤(9.1%)。体温过低与年龄(调整优势比[AOR]: 19.94, CI: 1.6 ~ 248.65, p = 0.02)、身体损伤部位(AOR = 6.28, CI: 1.6 ~ 27.75, p = 0.015)、环境温度(AOR = 0.09, CI: 0.01 ~ 0.6, p = 0.012)和保暖衣物(AOR = 0.05, CI: 0.01 ~ 0.39, p = 0.004)相关。复苏30分钟后,根据初始体温测量,大多数患者已从低温状态过渡到常温状态。这种复苏包括使用毯子和外部加热设备保持患者温暖,并给予加热的静脉输液。结论:39%的严重创伤患者存在低温,高龄和损伤部位是主要关联因素。常规体温监测至关重要,尤其是对老年患者和四肢损伤患者。医院应实施标准化的体温过低预防方案,确保有足够的取暖设备,并对医疗保健提供者进行早期发现和管理方面的培训。需要进一步的研究来优化创伤护理中的升温技术和复苏策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors associated with hypothermia and its response to resuscitation among major trauma patients at St Francis Hospital Nsambya: a prospective observational study.

Background: Hypothermia, defined as a core body temperature below 35 °C, is a common yet underappreciated complication among trauma patients. It leads to coagulopathy, impaired immune response, and higher morbidity, with mortality rates rising by 25% after its onset among severely injured trauma patients. This study sought to determine the factors associated with hypothermia and its response to resuscitation among major trauma patients at St. Francis Hospital Nsambya.

Methods: This was a prospective observational study among 99 adult major trauma patients admitted to the emergency department at St. Francis Hospital Nsambya between November 2022 and April 2023. Patients were consecutively enrolled upon arrival and their temperatures were taken using the Braun infrared tympanic thermometer. A pretested data abstraction tool collected information on demographics, injury characteristics, and pre-admission events. The primary outcome was the prevalence of hypothermia. Data analysis was conducted using STATA Version 17.0, employing multivariable logistic regression analysis to determine factors associated with hypothermia.

Results: A total of 99 trauma patients were included in the study, of which 39(39%) were hypothermic on hospital arrival. The majority were males, 78(78.8%) aged 26 to 45 years, 49(49.5%) (range: 27-52). Blunt trauma was the most common mechanism of injury 9(86.9%), followed by penetrating injuries 9(9.1%). Hypothermia was associated with age (Adjusted Odds Ratios [AOR]: 19.94, CI: 1.6-248.65, p = 0.02), body region injured (AOR = 6.28, CI: 1.6-27.75, p = 0.015), ambient temperature (AOR = 0.09, CI: 0.01-0.6, p = 0.012), and warm clothing (AOR = 0.05, CI: 0.01-0.39, p = 0.004). After 30 min of resuscitation, most patients had transitioned from a hypothermic state to a normothermic state, according to initial temperature measurements. This resuscitation involved keeping the patients warm using blankets and external warming devices and administering heated intravenous fluids.

Conclusion: Hypothermia affected 39% of major trauma patients, with advanced age and injured regions as key associations. Routine temperature monitoring, especially for older patients and those with extremity injuries, is essential. Hospitals should implement standardized hypothermia prevention protocols, ensure adequate warming equipment, and train healthcare providers in early detection and management. Further research is needed to optimize warming techniques and resuscitation strategies in trauma care.

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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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