目的:低温是老年人的一种严重疾病。了解潜在疾病的先验机会可能会影响初始管理,因此预后。本系统综述提供了有关急诊科老年患者体温过低的潜在原因的现有文献的概述。
方法:MEDLINE,科克伦图书馆,Embase被搜查到2月1日,2022年。纳入标准为年龄≥65岁,急诊科设置,体温<36.0摄氏度。排除标准是医源性低体温,没有潜在的原因报告,以及根据具体疾病选择患者。筛选标题/摘要和全文,并使用JoannaBriggs研究所批判性评估工具评估质量。数据采用描述性统计和叙述性分析。
结果:包括41份报告,包括6项队列研究和35例病例报告。这6项研究涉及2173名体温过低的患者,他们的年龄从平均67岁到中位数79岁不等,温度从中位数30.8摄氏度到平均值33.7摄氏度不等。一项研究报道了原发性低体温(发生率为44%)。急性医学疾病通常被报告为继发性低温的潜在原因(49-51%)。报告的感染和败血症发生率为10%至32%,高达14%的创伤,和5%至26%的酒精中毒。
结论:已经发表了关于该主题的有限研究,证据的总体质量被评为低.不应该错过的原因包括急性医学疾病,创伤,酒精中毒,原发性体温过低,甲状腺功能衰竭,和药物诱导的体温过低。
Hypothermia is a serious condition in older adults. Knowledge of a priori chances of underlying diseases may affect initial management, hence prognosis. This systematic
review provided an overview of existing literature on the incidences of underlying causes of hypothermia in older patients at the emergency department.
MEDLINE, The Cochrane Library, and Embase were searched up to February 1st, 2022. Inclusion criteria were age ≥ 65 years, emergency department setting, and body temperature < 36.0 degrees Celsius. Exclusion criteria were iatrogenic hypothermia, no underlying cause reported, and patient selection based on specific diseases. Title/abstract and full-text were screened and quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Data were presented using descriptive statistics and narrative analyses.
Forty-one reports were included, including 6 cohort studies and 35 case reports. The 6 studies involved 2173 hypothermic patients, whose age varied from a mean of 67 to a median of 79 years and temperature from a median of 30.8 to a mean of 33.7 degrees Celsius. One study reported about primary hypothermia (incidence of 44%). Acute medical illness was often reported as underlying cause of secondary hypothermia (49-51%). Reported incidences of infection and sepsis ranged from 10 to 32%, of trauma up to 14%, and of alcohol intoxication from 5 to 26%.
Limited studies have been published regarding this topic, and the overall quality of the evidence was graded as low. Causes that should not be missed include acute medical illness, trauma, alcohol intoxication, primary hypothermia, thyroid failure, and drug-induced hypothermia.