Application of two kinds of core temperature monitoring methods in target temperature management of patients with extracorporeal membrane oxygenation
2种核心温度监测方法在体外膜肺氧合患者目标温度管理中的应用

摘要

目的 比较体外膜肺氧合（extracorporealmembrane oxygenation, ECMO）患者鼻咽部和变温水箱两种核心温度监测方法的差异及相关性，为ECMO患者进行目标温度管理时核心温度监测提供更稳定可靠的方法。方法 选取2018年2月-2019年5月广东某三级医院重症医学科进行ECMO支持的患者作为研究对象，分别对同一患者同时采用鼻咽温度和变温水箱2种方式监测每小时目标温度维持期核心体温，比较2种方法的差异和相关性。结果 共纳入ECMO支持患者28例，男19例，女9例，其中鼻咽部测得温度为33.20（33.10，33.30）℃，变温水箱测得温度为33.00（33.00，33.10）℃，总体鼻咽部比变温水箱测得温度高（0.11±0.08）℃，两种方法比较，差异有统计学意义（Z=8.392，P<0.01），但均在目标温度管理范围内。两种方法测定核心体温的Spearman相关系数为0.824（P<0.01）呈高度正相关，Bland-Altman分析显示，2种监测方法测得体温一致性较高，平均差值为0.11℃（t=9.34，P<0.01，95％CI为（-0.047－0.266）。结论 变温水箱作为ECMO装置的一部分，其监测的目标温度维持期膜肺血液温度与鼻咽温度结果有差异，但相关性和一致性良好，为测量ECMO患者核心温度提供了新方法，且获得方便，对患者无损伤。

Abstract

Objective: To investigate the difference and correlation between two kinds of core temperature monitoring methods of nasopharyngeal and variable temperature water tank in patients with extracorporeal membrane oxygenation (ECMO)，and to provide a more stable and reliable method for core temperature monitoring during target temperature management.
Methods Patients with ECMO support admitted to the ICU of a tertiary hospital in Guangdong Province From February 2018 to May 2019 were selected . Nasopharyngeal temperature and variable temperature water tank were used to monitor the core temperature during the target temperature maintenance period of each hour at the same time for every patient, and the differences and correlations of two methods were compared.
Results A total of 28 patients with ECMO were included，including 19 males and 9 females. statistically significant was found between nasopharyngeal temperature with 33.20（33.10，33.30）℃ and variable temperature water tank with 33.00（33.00，33.10）℃.The total temperature of nasopharynx was (0.11 ± 0.08) ℃ higher than variable temperature water tank,but both were within the target temperature management range.Correlation analysis showed that the Spearman correlation coefficient of the 2 methods was 0.824 （P<0.01),which have a significantly positive correlation.
Conclusion   The results of blood temperature of membranous lung and nasopharynx in the target temperature maintenance period are different, but the correlation and consistency are satisfactory.As a part of ECMO device, It provides a new method to measure the core temperature of ECMO patients, which is convenient and non-invasive.