背景:意外低体温患者的最佳院前管理和治疗是一个经常争论的问题,争议通常围绕着复温的主题。传统上,对意外体温过低的患者进行初级急诊护理和急救的经验法则是避免院前主动复温,并着重于防止进一步的热量流失。基于对潜在并发症的恐惧,在院前环境中主动外部复温的潜在危险先前已在急诊医学界中普遍接受。如“后滴”,“复温综合征”,和“圆形救援倒塌”。这导致医疗保健提供者不愿意在医院外主动为患者提供外部复温。这些生理现象存在不同的理论和假设,但科学证据有限.研究问题是院前使用主动外部复温对意外低温患者是否有危险。本系统综述旨在描述主动外部复温对意外低温患者的急性不利不利影响。
方法:Cochrane图书馆的文献检索,MEDLINE,EMBASE,护理和相关健康文献累积指数(CINAHL),然后进行了SveMed+,所有文章均接受了资格筛选.包括所有文章格式。
结果:筛选了两千三百两篇文章,八篇文章符合我们的搜索标准。三篇文章是病例报告或病例系列,一个是前瞻性研究,两项是回顾性研究,一篇文章是文献综述,一篇文章是拿破仑战争的战争报告。
结论:本文的主要发现之一是科学质量差,满足我们纳入标准的文章数量少。在进行这次审查时,我们没有发现质量可接受的科学证据来证明在院前环境中使用主动外部复温对于意外低体温患者是危险的.我们发现了几篇文章声称积极的外部复温是危险的,但是他们中的大多数都没有引用参考文献或提供证据。
BACKGROUND: Optimal prehospital management and treatment of patients with accidental hypothermia is a matter of frequent debate, with controversies usually revolving around the subject of rewarming. The rule of thumb in primary emergency care and first aid for patients with accidental hypothermia has traditionally been to be refrain from prehospital active rewarming and to focus on preventing further heat loss. The potential danger of active external rewarming in a prehospital setting has previously been generally accepted among the emergency medicine community based on a fear of potential complications, such as \"afterdrop\", \"rewarming syndrome\", and \"circum-rescue collapse\". This has led to a reluctancy from health care providers to provide patients with active external rewarming outside the hospital. Different theories and hypotheses exist for these physiological phenomena, but the scientific evidence is limited. The research question is whether the prehospital use of active external rewarming is dangerous for patients with accidental hypothermia. This systematic review intends to describe the acute unfavourable adverse effects of active external rewarming on patients with accidental hypothermia.
METHODS: A literature search of the Cochrane Library, MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL], and SveMed+ was carried out, and all articles were screened for eligibility. All article formats were included.
RESULTS: Two thousand three hundred two articles were screened, and eight articles met our search criteria. Three articles were case reports or case series, one was a prospective study, two were retrospective studies, one article was a literature review, and one article was a war report from the Napoleonic Wars.
CONCLUSIONS: One of the main findings in this article was the poor scientific quality and the low number of articles meeting our inclusion criteria. When conducting this review, we found no scientific evidence of acceptable quality to prove that the use of active external rewarming is dangerous for patients with accidental hypothermia in a prehospital setting. We found several articles claiming that active external rewarming is dangerous, but most of them do not cite references or provide evidence.