院外劳力性热射病的降温护理方法分析

Analysis of the Cooling Nursing Methods for Out-of-hospital Labor-induced Heat Radiated Disease

目的探讨院外对于劳力性热射病采用综合降温措施的临床护理疗效分析。方法方便选取北京急救中心2016年5月—2018年9月该院前救治的70例高温环境下劳力性热射病患者,随机分成两组:对照组35例,采用单纯冰袋物理降温。实验组35例,采用快速脱离高温高湿环境,冰水或冷水擦拭身体,应用冰袋,头戴冰帽,降温毯的应用,快速输注4℃生理盐水或林格氏液等综合降温及护理方法。对比两组患者降温前的肛门温度,到达医院时肛门温度以及达到目标温度(38℃)所用时间,比较两组救治的成功率,死亡率及并发症发生率。结果实验组患者采用综合降温及护理方法治疗后到达医院时,有5例肛温达到目标温度,平均肛温(39.1±0.8)℃,低于对照组的(39.8±1.2)℃,差异有统计学意义(t=2.228,P<0.05)。实验组达到目标温度平均用时(1.5±1.1)h,低于对照组的(2.0±1.5)h,差异有统计学意义(t=2.234,P<0.05)。对照组35例患者病情严重,院前救治症状改善不明显,进一步送院内治疗。1例患者到达医院后死亡。抢救成功率97.14%,死亡率2.86%,并发症14.28%。实验组35例经过院前综合救治,患者症状改善明显,后经电话回访,全部治愈,抢救成功率100.00%,患者死亡率为0.00%,并发症2.86%,差异有统计学意义(χ2=4.450、6.230、4.150,P<0.05)。结论院外综合的降温及护理方法,能快速有效地使患者体温下降,增加救治成功率,降低死亡率及并发症发生率,值得在院外抢救中应用推广。

Objective To explore the clinical nursing effect of comprehensive cooling measures for labor-induced heat radiation disease outside the hospital.Methods A total of 70 patients with labor-induced thermal radiation sickness in high temperature environment treated in Beijing Emergency Center from May 2016 to September 2018 were randomly conveniently selected.They were randomly divided into two groups:the control group(35 cases),and the physical temperature was cooled by a simple ice pack.The experimental group of 35 patients were quickly removed from the high temperature and high humidity environment,using ice water or cold water to wipe their bodies,applying ice packs,wearing ice caps,and cooling blankets,and rapidly injecting 4°C physiological saline or Ringer's solution for comprehensive cooling and nursing method.The anus temperature before cooling,the anus temperature when arriving at the hospital,and the time taken to reach the target temperature(38°C)were compared between the two groups.The success rate,mortality and complication rate of the two groups were compared.Results When the patients in the experimental group arrived at the hospital after treatment with comprehensive cooling and nursing methods,5 cases of anal temperature reached the target temperature.The average anal temperature was(39.1±0.8)℃,which was lower than the control group(39.8±1.2)℃.The difference was statistically significant(t=2.228,P<0.05).The average time for the experimental group to reach the target temperature was(1.5±1.1)h,which was lower than the control group(2.0±1.5)h.and the difference was statistically significant(t=2.234,P<0.05).The 35 patients in the control group were seriously ill,and the symptoms of pre-hospital treatment did not improve significantly,and they were sent to hospital for further treatment.One patient died after arriving at the hospital.The rescue success rate was 97.14%,the mortality rate was 2.86%,and the complications were 14.28%.Thirty-five people in the experimental group received comprehensive pre-hospital treatment,and the symptoms of the patients improved markedly.After a return visit by telephone,all patients were cured.The rescue success rate was 100.00%.The mortality rate was 0.00%,the the complication was 2.86%.The difference was statistically significant(χ2=4.450,6.230,4.150,P<0.05).Conclusion The comprehensive cooling and nursing methods outside the hospital can quickly and effectively reduce the patient's body temperature,increase the success rate of treatment,reduce the mortality and the incidence of complications,which is worthy of application and promotion in the out-of-hospital rescue.