NICU患儿测量不同部位体温的观察与分析

目的研究测量颈温和背温的临床实用价值和可行性。方法采用自身对照法将腋、颈、背部测得的体温数据进行统计学分析。结果通过自身对照统计学分析，证明颈部、背部及腋窝温度差异无统计学意义（P〉0．05）。结论经过110例患儿自身对照法测得的体温，证实颈温和背温的测量在临床上具有可行性和实用性。     

发热患儿肛温与腋温测量值差异的研究

目的探讨发热患儿肛温测量值与腋温测量值加0．6℃之间的差异。方法将101例发热患儿采用自身对照的方法同时测量肛温与腋温,对肛温测量值与腋温测量值加06℃之间的差异进行比较分析。结果发热患儿肛温测量值与腋温测量值加0．6℃之间的差值在0～1．7℃之间,发热患儿肛温测量值与腋温测量值加0．6℃之间的差异具有统计学意义（P〈0．05）。结论发热患儿测量肛温更准确。     

儿童体温不同测试方法的观察

目的 比较口温、腋温、耳温测量法在儿童体温测试中的差异,以寻求一种简便、准确的儿童体温测量方法。方法对100例住院患儿在同一时间段测量口温、腋温、耳温,进行对比分析。结果腋温平均值为（37．11±1．01）℃,口温平均值为（37．65±0．99）℃,耳温平均值为（37．70±1．00）℃。结论根据测量结果,给儿童测量体温,可用耳温测量法代替口温、腋温测量法。     

新生儿背部肩胛体温测量与肛温测量的比较

目的：对新生儿背部肩胛温与肛温的测量比较,探讨背温能否代替肛温。方法：对353例新生儿同时测量肛温和背温,将数据进行比较对照。结果：正常组,发热组和暖箱组新生,背温和肛温数值无明显差异(P>0.05)结论：新生儿背温能准确反映机体的真实体温,且测背温具有操作简便、安全、省时等优点,可取代肛温测试法。     

烧伤患儿肛温和耳温测量的相关性研究

目的使用红外线鼓膜温度计测量0～8岁烧伤儿童的耳温,与传统体温测量方法肛温对照,探讨2种体温测量的相关性。方法同时测量118例烧伤患儿耳温和肛温。结果烧伤急诊单次测量患儿74例,其肛温和耳温的相关系数r=0.716,P<0.05,烧伤住院患儿44例,共测温426次,其肛温和耳温的相关系数r=0.868,P<0.05。<1岁的患儿肛温变异系数CV=0.83%,为各年龄层最小。结论红外线耳温测量仪可以应用于烧伤患儿测量体温,特别适用于急诊患儿和住院患儿的一般测量。     

小儿肛温和腋温测量值差异的观察

目的探讨小儿肛温和腋温测量值的差异.方法随机选择4～10岁的患儿105例对他们同时进行肛温和腋温测量.结果肛温比腋温至少高0.1℃,最大高2.5℃,平均高0.89℃,与目前临床上通常认为的肛温比腋温高0.5℃的观点有显著差异(p＜0.01).结论临床上通常在腋温基础上简单加0.5℃代表肛温的做法不正确,对小儿进行体温测量时不宜采用腋温测量法.     

暖箱内新生儿体温不同测量途径的对比研究

[目的]寻求暖箱中新生儿体温测量的最佳方法.[方法]对77例暖箱内新生儿同时测量其背温、腰温及肛温.[结果]暖箱中新生儿背温、腰温均与肛温存在正相关关系;方差分析显示三者间差异无统计学意义;两两比较显示,背温与肛温之间差异有统计学意义,腰温与肛温比较差异无统计学意义.[结论]腰温测量方法简便、安全,可作为暖箱内新生儿体温测量方法.     

暖箱内新生儿体温不同测量途径的对比研究

[目的]寻求暖箱中新生儿体温测量的最佳方法。[方法]对77例暖箱内新生儿同时测量其背温、腰温及肛温。[结果]暖箱中新生儿背温、腰温均与肛温存在正相关关系;方差分析显示三者间差异无统计学意义;两两比较显示,背温与肛温之间差异有统计学意义,腰温与肛温比较差异无统计学意义。[结论]腰温测量方法简便、安全,可作为暖箱内新生儿体温测量方法。     

NICU中集体测量患儿体温最佳部位的临床研究

目的探寻NICU中集体测量患儿体温的最佳部位。方法将睡在暖箱中、远红外暖床上、单面光疗箱中、婴儿床里的足月儿和早产儿共210例分别测量颈温、背温、腹温、肛温并进行统计学分析,采用t检验。结果暖箱和单面光疗箱中的足月儿、早产儿的背温与肛温无显著性差异(P>0.05),远红外暖床上和婴儿床里的足月儿的背温与肛温无显著性差异(P>0.05),远红外暖床上的早产儿的背温与肛温有显著性差异(P<0.05),背温低于肛温。结论除远红外暖床上的早产儿外,其他不同环境下测量患儿背温是N ICU中集体测量体温的最佳方法。     

中枢性高热患者耳温测量的临床研究

目的探讨中枢性高热患者耳温测量的临床意义。方法选择2006年1月～12月收治神经科住院,使用电子冰帽治疗的脑血管病中枢性高热患者30例,每2h测量并记录治疗前后患者同侧的耳温及腋温,用红外线鼓膜温度计测量耳温,用水银温度计测量腋温,采用自身对比法分析耳温与腋温的差异。结果(1)同一患者应用电子冰帽的耳温测量值高于同侧腋温,P<0.05;(2)应用冰帽后耳温下降幅度大于腋温下降幅度,以6h内下降最明显,P<0.01;12h、24h两部位温差相比,P<0.05。结论相同条件下,耳温比腋温更能较早准确地反映脑温的变化,指导临床治疗,改善预后,且测量耳温操作简单,节省时间,可准确提供患者脑温变化的信息,值得在临床应用和推广。     

ICU患者体温测量方法现状分析

目的分析重症监护病房(intensive care unit,ICU)体温监测现状,为进一步探讨危重患者最佳体温测量方法提供参考。方法 2013年1月,便利抽样法选取北京、上海、成都、乌鲁木齐等地5所三级甲等医院的35个ICU为研究对象,实地调查ICU监测患者体温所采用的工具、测量部位及方法等。结果 35个ICU中,用水银体温计测量腋窝温度的使用率为91.43%;用监护仪配备的体温监测导线持续监测直肠内温度的使用率为2.86%;用红外线温度扫描仪分次测量额温的使用率为2.86%。结论目前三级甲等医院ICU多以水银体温计间歇测量腋窝温度作为体温测量的主要方法,应尽快找到更好的体温测量工具和部位,并实现持续监测。     

手术患者术中测温方式的最佳证据总结

目的 选择并获取国内外手术患者术中测温方式的相关证据,总结出最佳证据。方法 系统检索Up To Date、Cochrane Library、BMJ、NGC、PubMed、SCCM、NICE、JBI、CINAHL、Medline、医脉通、中国知网、万方数据库,关于手术患者术中测温方式的所有证据,包括指南、证据总结、标准、系统评价、专家共识。期间由2名循证研究者对文献质量进行独立评价,对符合质量标准的文献进行内容获取。结果 共纳入12篇文献,其中指南2篇,专家共识2篇、系统评价5篇、最佳实践信息册1篇、证据总结2篇,获取的证据进行汇总,最终从4个维度进行总结获取18条最佳证据。结论 证据获取以选择最佳的测温方式,排除鼻、咽部手术的患者,鼻咽温是手术患者最佳的测温方式;鼻、咽部手术患者膀胱温是最佳测温方式;手术室发生低体温风险大,做到术中实时监测体温,预防术后并发症,改善生存质量。     

Low Temperature and Low Energy Radiofrequency Modification of Atrioventricular Nodal Slow Pathways in Pediatric Patients

OBJECTIVES: To report our experience using low temperature and energy in the modification of the slow pathway in pediatric patients with atrioventricular nodal reentrant tachycardia. BACKGROUND: A concern in performing a slow pathway modification is the possible damage of the normal AV conduction system. Lesion size has been shown to have a linear relationship with temperature. Previous reports have used energy of 25-50 W that generate temperatures of 60 degrees C -70 degrees C for successful procedures. METHODS: Report of results of attempted AV nodal slow pathway modification in 17 consecutive pediatric patients < 15 years of age at The Children's Hospital of Philadelphia from April 1995 to November 1997 using low temperature and energy. RESULTS: There were 18 successful slow pathway modifications with 1 recurrence in 17 patients. The maximum energy used during successful lesions was 32.7 +/- 13.8 W (range 15-50 W) with a mean energy of 26.4 +/- 13.3 W (range 12-48 W). The peak temperature during these lesions was 55.1 degrees C +/- 4.1 degrees C (range 48 degrees C-64 degrees C) with a mean temperature of 47.9 degrees C +/- 2.7 degrees C (range 44 C-540C). The mean number of radiofrequency lesions required for a successful modification was 5.8 +/- 6.7 (median 4.0, range 1-26). Patients have been followed for 2.08 +/- 0.79 years. CONCLUSIONS: Slow pathway modification can be performed successfully with a low incidence of recurrence in the pediatric patient using low energy and temperature. It is possible that this may lead to smaller lesions.     

神经内科住院患者体温测量方法的探讨

目的探讨使用红外线耳温计测量神经内科住院患者体温的可行性。方法测量2009年9—12月神经内科316例住院患者的耳温、口温、腋温,对比同组患者左右耳的温度,比较耳温与口温、腋温的差异。结果患者左右两耳温度差异无统计学意义(P>0.05),患者耳温、口温和腋温3者之间差异有统计学意义,同时任何两组之间的差异均有统计学意义(P<0.05)。结论红外线耳温测量仪可以应用于神经内科住院患者测量体温,能较好反映患者体核温度,且操作简单方便,值得临床推广应用。     

Markers of Overcrowding in a Pediatric Emergency Department

Objectives: The objective of this study was to identify markers of overcrowding in pediatric emergency departments (PEDs) according to expert opinion and then to use statistical methods to further explore the underlying construct of overcrowding. Methods: A cross‐sectional survey of all PED directors (n = 12) and pediatric emergency medicine fellowship program directors (n = 10) across Canada was conducted to elicit expert opinion on relevant markers of emergency department (ED) crowding. The list of markers was reduced to those specific to the ED for which data could be extracted from one tertiary care PED from an existing computerized patient tracking system. Data representing 2,190 consecutive shifts and 138,361 patient visits were collected between April 2005 and March 2007. Common factor analysis (CFA) was used to determine the underlying factors that best represented overcrowding as determined by markers identified by experts in pediatric emergency medicine Results: The main markers of overcrowding identified by the survey included measures of patient volume (25%), ED operational processes (55%), and delays in transferring patients to inpatient beds (13%). Data collected on 41 markers were retained for the CFA. The results of the CFA indicated that the largest portion of variation in the data (48%) was accounted for by markers describing patient volumes and flow through the ED. Measures of admission delays accounted for a smaller proportion of variability (9%). Conclusions: The results suggest that for this tertiary PED, markers of ED operational processes and patient volume may be more relevant for determination of overcrowding than markers reflecting delays in transferring patients to inpatient beds. This study provides a foundation for further research on markers of overcrowding specific to the pediatric setting. ACADEMIC EMERGENCY MEDICINE 2010; 17:151–156 © 2010 by the Society for Academic Emergency Medicine     

腹股沟与腋窝测温法的对比研究

目的 探讨大面积烧伤患腹股沟测温法的可行性。方法 选择住院患200名,分成4组,每位患同时测量腋窝／腹股沟体温。结果 将每组患的左右腋下体温、左右腹股沟体温和同侧腋窝／腹股沟体温进行样本均数的t检验,P＞0．05。结论 腹股沟测温法代替常规腋窝测温法,在大面积烧伤及特殊患上的应用是科学可行的。     

Emergency Department Management of Pediatric Patients with Cyanotic Heart Disease and Fever

Background

Children with cyanotic congenital heart disease (CCHD) are living longer and presenting to the Emergency Department (ED) in larger numbers. A greater understanding of their diagnoses and appropriate management strategies can improve outcomes.

Objective

Our objective was to describe the ED diagnoses, management, and dispositions of pediatric CCHD patients who present with fever.

Methods

We retrospectively analyzed pediatric ED patients age 18 years or younger with a previous diagnosis of CCHD who presented with a fever from January 2000 to December 2005.

Results

Of 809 total ED encounters, 248 (30.6%) were eligible for inclusion. Of those meeting inclusion criteria, 59 (23.8%) required supplemental oxygen and 67 (27%) received intravenous fluid. ED diagnoses were febrile illness in 120 (48.4%), pneumonia in 35 (14.1%), upper respiratory infection in 19 (7.7%), viral syndrome in 17 (6.9%), gastroenteritis in 17 (6.9%), otitis media in 10 (4.0%), bronchiolitis in 5 (2.0%), pharyngitis in 3 (1.2%), croup in 3 (1.2%), bronchitis in 3 (1.2%), urinary tract infection in 3 (1.2%), mononucleosis in 2 (0.8%), pericarditis in 2 (0.8%), influenza in 1 (0.4%), cellulitis in 1 (0.4%), bacteremia in 1 (0.4%), and potential endocarditis in 1 (0.4%). In terms of patient disposition, 53.2% were discharged, 44.4% were floor admissions, and 2.4% were intensive care unit admissions.

Conclusions

A cardiac cause of fever in CCHD patients is rare. Because of limited cardiopulmonary reserve, they might require supplemental oxygen, intravenous fluids, and hospital admission.     

Patient Satisfaction in the Emergency Department—A Survey of Pediatric Patients and Their Parents

OBJECTIVES: To assess and compare overall satisfaction in pediatric emergency department (ED) patients and their accompanying parents. To identify aspects of health care delivery that influence satisfaction in these groups. METHODS: Pediatric patients (ages 5-17 years) and their parents (or guardians) seen at a university hospital pediatric ED were eligible. A convenience sample of English-speaking subject pairs (n = 101 pairs) was enrolled. Questionnaires were administered to both children and their parents at the completion of their ED care. The survey instruments used a modified Wong-Baker FACES Pain Rating Scale and a six-point interval scale. Factors measured included overall satisfaction, perceptions of pain and fear, and other characteristics of the ED visit. Data were analyzed using paired Wilcoxon signed-rank tests, Spearman rank correlation coefficients, and Fischer's exact chi-square tests (alpha = 0.05) where appropriate. RESULTS: Parent satisfaction was associated with the quality of provider-patient interactions (R = 0.54, p = 0.0001), the adequacy of information provided (R = 0.47, p = 0.0001), and shorter waiting room times (R = -0.24, p = 0.01). Child satisfaction was associated with the quality of provider-patient interactions (R = 0.24, p 0.04), adequacy of information provided (R = 0.51, p = 0.003), and resolution of pain (R = 0.25, p = 0.03). Parent estimates were similar to children's initial pain scores; however, children reported greater resolution of pain than appreciated by their parents (p = 0.006). CONCLUSIONS: Satisfaction can be validly and reliably measured in pediatric patients using a visual scale instrument. Factors that influence patient satisfaction were similar among both children and their parents. The influence of pain resolution on pediatric ED satisfaction is a novel finding, which demonstrates the importance of appropriate pain and anxiety assessment and treatment in children.