摘要
目的探讨系统分级复温模式对低体温创伤患者不同时段全因死亡的影响。方法采用随机对照临床试验研究,纳入2020年1月至2021年12月温州医科大学附属第二医院急诊科收治的236例修正创伤评分<12分的低体温创伤患者,按随机数字表法将患者分为系统分级复温组和传统复温组,每组118例。研究的主要结局事件是伤后15 d内全因死亡。次要结局事件是伤后3、7、30 d内全因死亡。结果13.98%(33/236)的患者在伤后15 d内死亡,14.83%(35/236)的患者在伤后30 d内死亡,所有死亡患者的中位生存时间为6(4,10)d。与传统复温组比较,系统分级复温组的复温后2 h体温更高(P=0.001),复温干预前后体温变化更大(P=0.047),差异均有统计学意义。系统分级复温组的15 d(27.3%比72.7%,P=0.005)和30 d(25.7%比74.3%,P=0.002)死亡率低于传统复温组。Kaplan-Meier分析显示系统分级复温组患者的生存时间长于传统复温组,差异有统计学意义(P=0.003)。多变量cox回归分析显示,采用系统分级模式复温是伤后生存时间的强保护因素(HR=0.450,P=0.042)。进一步对各时段全因死亡的发生进行Logistic回归分析,结果显示校正协变量后,采用系统分级复温模式对患者发生伤后15 d和30 d内全因死亡的OR值分别为0.289和0.286(P=0.008,P=0.005),复温后2 h体温与伤后30 d内全因死亡的发生呈负相关(OR=0.670,P=0.049)。结论系统分级模式复温是创伤低体温患者伤后生存时间的保护因素,采用系统分级复温模式是伤后15 d和30 d内全因死亡发生风险的独立影响因素。复温后2 h体温有望成为低体温创伤患者伤后30 d全因死亡的独立预测因子。应用系统分级复温模式能够降低创伤患者的死亡率。
Objective To investigate the effect of systematic graded rewarming pattern on all-cause mortality of hypothermic trauma patients in different time periods.Methods A prospective case-control study was carried out for 236 hypothermic trauma patients with modified trauma score<12 in the Emergency Department of the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2021.The patients were randomly assigned into a systematic graded rewarming group(n=118)and a traditional rewarming group(n=118).The main outcome event was all-cause death within 15 days after trauma,and the secondary outcome event was all-cause death within 3,7,and 30 days after trauma.Results Overall,13.98%(33/236)and 14.83%(35/236)of the patients died within 15 and 30 days after trauma,respectively,and the median survival time of all dead patients was 6(4,10)days.The systematic graded rewarming group had higher temperature after rewarming for 2 h(P=0.001)and larger temperature change after rewarming intervention(P=0.047)than the traditional rewarming group.The all-cause mortality within 15 days(27.3%vs.72.7%,P=0.005)and 30 days(25.7%vs.74.3%,P=0.002)in the systematic graded rewarming group was lower than that in the traditional rewarming group.Kaplan-Meier analysis showed that the survival time of the patients in the systematic graded rewarming group was longer than that in the traditional rewarming group(P=0.003).Multivariate cox regression analysis indicated that systematic graded rewarming was a strong protective factor for survival time after trauma(HR=0.450,P=0.042).Further Logistic regression analysis for the occurrence of all-cause death in each time period showed that the OR of systematic graded rewarming pattern to all-cause death within 15 days and 30 days after trauma were 0.289 and 0.286,respectively,after adjusting the covariates(P=0.008,P=0.005).The temperature after rewarming for 2 h had a negative correlation with all-cause mortality within 30 days after trauma(OR=0.670,P=0.049).Conclusions Systematic
作者
吕洋洋
卢阳阳
黄海群
郑婷婷
颜雷雷
Lü Yangyang;LU Yangyang;HUANG Haiqun;ZHENG Tingting;YAN Leilei(Department of Emergency,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2023年第2期213-220,共8页
Acta Academiae Medicinae Sinicae
基金
浙江省医药卫生科技计划项目(2020KY189)。
关键词
系统分级复温
创伤
低体温
全因死亡
systematic graded rewarming
trauma
hypothermia
all-cause mortality
