急診17例低溫症臨床回顧與分析

Clinical review and analysis 17 hypothermia cases in the A&E department

目的回顧分析2016年鏡湖醫院急診科就診的低溫症患者的臨床特點和復溫治療,為本地低溫症的防治及護理提供科學依據。方法2016年1月~2016年4月間到鏡湖醫院急診科就診的低溫症個案共17例,根據當天氣溫,患者性別、年齡、體溫分級、社會背景,復溫方法及轉歸進行統計和分析。結果發病當天平均氣溫為10.7℃,患者平均年齡74歲,男性12例,女性5例,全部為非獨居人士,發病時均處於室內。輕度低溫症者13例,中度低溫症者3例,重度低溫症者1例,體徵上神智改變最為多見,其次為低血壓,實驗室檢查中電解質紊亂最常見,其次為低血糖,心電圖檢查中心肌缺血最常見,其次為心動過緩和房顫。7名患者合併糖尿病,10名患者合併高血壓,好轉收入院者13例,死亡4例,1例使用了暖氈,13例使用了暖爐,13位病人使用了加溫輸液器,急診處理後體溫恢復到35℃以上5人,未能復溫者12人。結論澳門地區在冬季,長者,慢性病患者是低溫症高危人群,大部份為輕度低溫症,需要加強該人群的護理支援,急診應根據低溫症臨床分級予以合理的復溫護理與治療。

Objective To review and analyze the clinical characteristics and rewarming strategy of hypothermia patients in A&E department of Kiang Wu Hospital in 2016,providing evidence for local hypothermia prevention and nursing care.Methods Between January to April 2016,total 17 cases of hypothermia were seen in the A&E department of Kiang Wu Hospital.Their demographic and clinical data were analysis in terms of daily temperature,gender,age,body temperature classification,social background,rewarming techniques and outcome.Results The average onset ambient temperature was 10.7℃,and the average age was 74 years,with 12 males and 5 females.There was no living alone person and all cases occurred indoor,13 cases with mild hypothermia,3 cases with moderate hypothermia and 1 case with severe hypothermia.7 patients had diabetes,and 10 patient had hypertension.Altered consciousness,electrolyte imbalance,cardiac ischemia were the most common clinical characteristics.Thirteen cases were hospitalized and improved,while four cases were certified dead in A&E.One patient was treated with warm blankets and thirteen cases with heaters.Thirteen patients were treated with warming infusion techniques,and five cases the body temperature restored above 35℃after treatment,while in 12 cases failed to achieve rewarming.Conclusion Elderly,people with chronic diseases were at considerable risk of hypothermia in winter of Macao,and the majority was with mild hypothermia.The home support and care for the elderly population need to be strengthened.Patients with hypothermia should be adequately rewarmed and treated according to clinical classification.