严重腹部创伤患者目标温度管理研究

Targeted temperature management of patients with severe abdominal trauma

目的探讨对严重腹部创伤患者实施目标温度管理的效果。方法将2016年收治的严重腹部创伤患者50例设为对照组,采用传统的体温护理方法;2017年收治的47例设为干预组,采用目标温度管理策略进行体温复苏管理。比较两组患者入院至损伤控制性手术前复苏时间,以及在2个时间点的体温、pH值及凝血功能相关指标。结果在损伤控制性手术前,干预组复苏时间、体温、血pH值、乳酸、凝血反应时间、凝血形成时间显著优于对照组(P<0.05,P<0.01)。两组凝固角、最大振幅、纤维蛋白溶解率及纤维蛋白溶解百分数比较,差异无统计学意义(均P>0.05)。结论目标温度管理策略可明显改善创伤患者低体温的发生,预防酸中毒和凝血功能紊乱的发展,为患者行确定性手术赢得时间。

Objective To explore the effect of targeted temperature management in patients with severe abdominal trauma.Methods A total of 50 patients with abdominal trauma hospitalized in 2016 were selected as the control group, whose body temperature was kept by using routine warming methods. Another 47 patients with abdominal trauma hospitalized in 2015 were assigned into the intervention group, who received target temperature management. The length of time from hospital admission to damage-control-surgery(DCS), the temperatures at the two time points, serum pH values, blood coagulation indexes between the 2 groups were compared. Record and compare the two groups of patients in ICU after 0 h, the Traumatic resuscitation time, pH, lactic acid, blood coagulation reaction time(R), clotting time(K), Angle of solidification(alpha Angle), maximum amplitude(MA), fibrinolysis rate(LY30) and the percentage of fibrinolysis(EPL).Results The time to DCS, the above mentioned temperatures, serum pH values, lactic acid, blood coagulation reaction time(R values) and clotting time(R values) between the 2 groups had significant differences, all favoring the intervention group(P<0.05,P<0.01). The results of angle of solidification(alpha Angle), maximum amplitude(MA), fibrinolysis rate(LY30) and the percentage of fibrinolysis(EPL) had no significant differences between the 2 groups(P>0.05 for all).Conclusion Targeted temperature management strategy can significantly lower the occurrence rate of hypothermia in trauma patients, prevent the development of acidosis and coagulation dysfunction, and save time for patients awaiting the deterministic operation.