“三明治”法冰毯降温治疗中枢性高热疗效观察

Efficacy of sandwich method of ice blanket cooling for central high fever

目的 探讨“三明治”法冰毯降温治疗中枢性高热的效果及并发症.方法 选择中枢性高热患者40例,根据冰毯降温方法的不同,将患者随机分成观察组（n=20）和对照组（n=20）.对照组接受背部单层冰毯降温,观察组采用背部及前部同时冰毯降温（“三明治”法）.2组均采用设置水温模式降温,水温设置为10℃.用肛温表连续监测患者核心体温,36 ～ 37℃为降温目标.结果 降温开始后第lh,2组患者体温变化无明显差别（P＞0.05）;第2、4h,观察组体温均较对照组体温明显下降（P＜0.01）.降温开始后4h内观察组体温达标,而对照组体温未达标.降温期间,观察组皮肤发红、腹泻、心律失常发生率与对照组相比差异无统计学意义（P＞0.05）.观察组寒战及躁动发生率显著低于对照组（P＜0.05）.结论 “三明治”法冰毯治疗中枢性高热降温较单层冰毯降温更加高效,不良反应少,值得临床推广应用.

Objective To investigate the efficacy of sandwich method of ice blanket cooling for central high fever and its complications. Methods 40 patients with nerval fever were randomly divided into two groups （observation group and control group, n =20 each） according to different methods of electric ice blanket cooling. One ice blanket was used behind the patients in the control group, while two ice blankets were used both in front of and behind the patients in the observation group. The water temperature in the two groups was both set at 10℃, the core body temperatures were meas ured continuously through rectum and the target temperature was 36 -37℃. Results There was no significant difference in the temperature between the two groups at 1 h of fever control therapy （ P 〉 0.05 ）. The temperature in the obsservation group was significantly lower than that in the control group both at 2 h and 4 h of fever control therapy （ P 〈 0.01 ）. After cooling for 4 h, the observation group reached the target temperature while the control group did not. The complications associated with iec blanket cooling such as redness of the skin, diarrhea, and arrhythmia were not significantly different between the two groups （ P 〉 0.05 ）. The rates of shivering and dysphoria were significanly lower in the experimental group than in the control group （P 〈0. 05）. Conclusion Sandwich method of ice blanket cooling is more effective for central high fever, with less side effects than single blanket method, so it is worthy of clinical application.