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室外是寒冷的,让体内温暖起来
原作者: Haney Mallemat, 江利冰 发布日期:2015-12-07

Title: Cold on the outside, make 'em warm on the inside
题目:室外是寒冷的,让体内温暖起来
Author 作者: Haney Mallemat
翻译:江利冰 校对:肖锋

Each year approximately 1,300 Americans die of hypothermia.
每年大约有1300例美国人死于低温。

Classification of hypothermia:
低温的分类:

• Mild (32-35 Celsius): shivering, hyperventilation, tachycardia, but patients are usually hemodynamically stable.
• 轻度(32-35℃):寒战,过度通气,心动过速,但是患者的血流动力学通常是稳定的。
• Moderate (28-32 Celsius): CNS depression, hypoventilation, loss of shivering, risk of arrhythmias, and paradoxical undressing
• 中度(28-32℃):中枢抑制,换气不足,寒战消失,具有发生心律失常的风险,以及反常脱衣现象。
• Severe (<28 degrees Celsius): increased risk of ventricular tachycardia/fibrillation, pulmonary edema, and coma
• 重度(<28℃):发生心动过速/心室颤动的风险增加,肺水肿以及昏迷。

The risk of cardiac arrest increases when the core temperature is less than 32 Celsius and significantly rises when the temperature is less than 28 Celsius. Rapid rewarming is required as part of resuscitation should cardiac arrest occur.
当中心体温低于32℃时,发生心脏骤停的风险增加,当中心体温低于28℃时,发生心脏骤停的风险显著增加。在发生心脏骤停之前,应将快速复温纳入复苏方案。

A rescue therapy to consider (when available) is extra corporeal membrane oxygenation (ECMO). ECMO not only provides circulatory support for patients in cardiac arrest, but allows re-warming of patients by 8-12 Celsius per hour.
一项可以考虑的抢救性策略是体外膜肺氧合(如果具备条件)。体外膜肺氧合不仅可以提供循环支持,还可以每小时复温8-12℃。

Some studies quote survival rates of 50% with hypothermic cardiac arrest patients receiving ECMO versus 10% in similar patients who do not receive ECMO.
一些研究指出,低温导致的心脏骤停使用体外膜肺氧合的患者生存率为50%,而不使用体外膜肺氧合的患者生存率为10%。

As winter just began, consider speaking to your cardiac surgeons now to plan an Emergency Department protocol for hypothermic patients that may require ECMO.
由于冬季刚刚开始,现在就和心脏外科医师提出对于那些可能需要体外膜肺氧合的低温症患者,建议建立急诊室救治规范。

References
参考文献
Ginty, et. Al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success American Journal of Emergency Medicine 2014 December 3
http://www.ncbi.nlm.nih.gov/pubmed/25534814