ICU患者连续性肾脏替代治疗24 h内低体温研究

Hypothermia in ICU patients during the first 24 hours of continuous renal replacement therapy

目的了解ICU患者连续性肾脏替代治疗24 h内低体温发生率及体温变化趋势,为优化连续性肾脏替代治疗体外加温方案提供参考。方法通过医院电子病历系统、重症监护护理系统、连续性肾脏替代治疗护理记录单回顾性收集2019年行连续性肾脏替代治疗的ICU患者一般资料,连续性肾脏替代治疗相关资料,连续性肾脏替代治疗启动后0~h、4~h、8~h、12~24 h最低体温。结果共纳入213例ICU患者的784例次数据。84例患者(39.4%)发生低体温(核心体温<36℃);低体温患者的APACHEⅡ评分和序贯器官衰竭估计评分、病死率显著高于非低体温患者(均P<0.01)。122例次(15.6%)连续性肾脏替代治疗运行过程出现低体温,其中运行4 h内体温下降显著(P<0.05),随后20 h内体温无明显回升;低体温组机械通气率更高,治疗前体温更低(均P<0.01)。结论ICU患者连续性肾脏替代治疗低体温发生率较高,且24 h内体温复温效果不理想,常规的保温/复温方案有待进一步优化。

Objective To understand the occurrence of hypothermia and changes of temperatures in ICU patients during the first 24 hours of continuous renal replacement therapy(CRRT)and to provide reference for improving warming techniques.Methods A retrospective study was conducted.Demographic data of the ICU patients on CRRT in 2019,CRRT flow parameters,and the lowest body temperatures within 0-,4-,8-and 12-24 h after CRRT initiation were collected through the electronic medical record system,intensive care information system and CRRT nursing record sheet.Results A total of 784 CRRTs performed in 213 patients were analyzed.Hypothermia(core temperature<36℃)was noted in 84 patients(39.4%)and their APACHEⅡscore,SOFA score and the mortality rate were significantly higher compared with those without hypothermia(P<0.01 for all).Hypothermia was developed in 122 CRRTs(15.6%)and the temperature decreased significantly within 4 hours after CRRT initiation(P<0.05),whereas it wasn′t enhanced within the next 20 hours.The rate of mechanical ventilation was higher,whereas the body temperature before CRRT was lower during the CRRT treatments which developed hypothermia(P<0.01 for both).Conclusion The prevalence of hypothermia within 24 hours after CRRT initiation is relatively high in ICU patients,and the rewarming effect is not satisfactory,indicating the conventional heat preservation/rewarming techniques need to be further optimized.