热射病患者院内早期体温管理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2025.05.008

摘要/Abstract

摘要：

目的构建热射病患者院内早期体温管理方案并探讨其应用效果，为热射病患者院内快速降温和精准目标体温管理提供指导。方法通过查阅文献、专家函询结合专家小组会议，构建热射病患者院内早期体温管理方案。采用多中心非随机历史对照研究，通过便利抽样，选取2024年6月—8月浙江省7所三级综合医院急诊就诊的59例热射病患者为试验组，实施院内早期体温管理方案，回顾性收集2022年6月—8月方案实施前急诊就诊的126例热射病患者为对照组。比较两组降温速率、目标体温达成率和临床结局的差异。结果热射病患者院内早期体温管理方案包括6个一级指标、23个二级指标、56个三级指标。试验组最终纳入59例，对照组最终纳入126例。实施方案后，试验组在入院0.5 h内的降温速率0.08（0.05~0.09） ℃/min，高于对照组0.04（0.02~0.06） ℃/min，两组比较差异具有统计学意义（P<0.001）。试验组0.5 h与2.0 h目标体温达成率分别为55.93%和98.31%，高于对照组15.87%和61.11%，两组比较差异均具有统计学意义（P<0.001）。试验组机械通气率、收治住院率、ICU入住率与病死率分别为25.42%、61.02%、44.07%、8.47%。Logistic回归分析显示，实施院内早期体温管理方案可降低热射病患者机械通气与收治住院风险（OR值分别为0.294，0.300，均P<0.05）。结论该研究构建的热射病患者院内早期体温管理方案具有科学性、系统性及实用性，可提高降温速率与目标体温达成率，改善热射病患者预后。

关键词: 热射病, 体温管理, 早期干预, 德尔菲技术, 护理

Abstract:

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness，providing guidance for rapid cooling and precise target temperature control. Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings. A multi-center，non-randomized，historical control study was conducted，utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province，China，between June and August 2024 as an experimental group. The protocol was implemented in this group，while the control group consisted of heat stroke patients treated between June and August 2022，prior to protocol implementation. Cooling rates，target temperature attainment rates，and clinical outcomes were compared between the 2 groups. Results The final protocol included 6 primary indicators，23 secondary indicators，and 56 tertiary indicators. After protocol implementation，the experimental group achieved a cooling rate of 0.08（0.05~0.09） °C/min within 0.5 hours，significantly higher than the control group，which had a rate of 0.04（0.02~0.06） °C/min（P<0.001）. The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93% and 98.31%，respectively，significantly higher than the rates of 15.87% and 61.11% in the control group（P<0.001）. The mechanical ventilation rate，hospitalization rate，ICU admission rate，and mortality rate in the experimental group were 25.42%，61.02%，44.07%，and 8.47%，respectively. Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients，with odds ratios（ORs） of 0.294 and 0.300，respectively（both P<0.05）. Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific，systematic，and practical. It improves cooling rates and target temperature attainment，thereby enhancing the prognosis of heat stroke patients.

Key words: Heat Stroke, Temperature Management, Early Intervention, Delphi Technology, Nursing Care

陈岚, 马慧敏, 方园, 张欢, 任菁南, 卢黎云, 吴湘靓, 刘畅, 金丁萍, 封秀琴. 热射病患者院内早期体温管理方案的构建及应用研究[J]. 中华护理杂志, 2025, 60(5): 561-568.

CHEN Lan, MA Huimin, FANG Yuan, ZHANG Huan, REN Jingnan, LU Liyun, WU Xiangliang, LIU Chang, JIN Dingping, FENG Xiuqin. Construction and application of an early in-hospital temperature management protocol for patients with heat stroke[J]. Chinese Journal of Nursing, 2025, 60(5): 561-568.

图/表 4

表1 热射病患者院内早期体温管理方案

Table 1 Early temperature management protocol for patients with heat stroke in the in-hospital stages

表2 两组一般资料和降温措施的比较

Table 2 Comparison of general data and cooling methods between the 2 groups

表3 两组降温效果的比较

Table 3 Comparison of cooling effectiveness between the 2 groups

表4 两组临床结局指标的Logistic回归分析

Table 4 Logistic regression analysis of clinical outcome indicators for the 2 groups

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