Abstract
Objective: to reveal the patterns of a change in heart rhythm and breathing in patients with acute systemic injury due to cold in hypothermic and early posthypothermic periods. Subjects and methods. Thirty patients aged 18 to 60 years (3 groups of 10 patients with mild, moderate, and severe cold injury) were examined in hypothermic and posthypothermic periods. The patient groups did not differ in gender, age, and weight. Within the first 24 hours after admission, all the patients underwent high-resolution Holter electrocardiographic monitoring that recorded cardiac arrhythmias and breathing disorders. Results. During the therapy performed, as the degree of acute systemic cold injury increased, the patients were found to have a heart rate reduction (from 102 [90; 122] beats/min in Group 1 to 49 [38; 58] beats/min in Group 3) and a circadian index increase (from 105 [88; 125]% in Group 1 to 210 [185; 223]% in Group 3). With increased hypothermia, the victims were detected to have progressive cardiac rhythm and cardiac electrical conduction disturbances, such as supraventricular pacemaker migration, single and paired supraventricular premature beats, paroxysmal atrial tachycardia, atrial fibrillations, and ventricular premature beats. There was decreased heart rhythm variability in all the study groups, to the greatest extent in the patents with severe systemic cold injury. Late ventricular potentials were found in 2 and 7 patients with moderate and severe cold injury, respectively. Breathing disorders were recorded in all the study groups, the greatest increase in the frequency and duration of apnea/hypopnea episodes was noted in the patients with severe hypothermia. A fatal outcome occurred in 4 of the 10 patients with critical hypothermia due to the occurrence of idioventricular rhythm with transition to asystole. Conclusion. Systemic hypothermia is accompanied by cardiac rhythm and cardiac electrical conduction disturbances and respiratory depression, which progress with the higher degree of acute systemic cold injury and, in case of critical hypothermia, may lead to a fatal outcome.
Highlights
Известно, что холодовая травма часто встречается в регионах Сибири и на Крайнем Севере, где поражение организма холодом является краевой патологией
The study included 30 patients (18—60 years old) subdivided into three groups of injured patients, 10 patients per group, with mild, moderate and severe course of Injury due to cold (IDC) hospitalized in Intensive Care Unit (ICU) of Regional Thermal Injury Center of the First city clinical hospital of the Chita city
In a group with a mild hypothermia in 100% of cases the alcohol use was defined; in patients with moderate and severe IDC two cases/each group with alcohol use combined with brain trauma were diagnosed
Summary
Что холодовая травма часто встречается в регионах Сибири и на Крайнем Севере, где поражение организма холодом является краевой патологией. Патоге нез и танатогенез холодовой травмы требует уточнения. При острой общей холодовой травме (ООХТ) минимальная температура тела, совместимая с жиз нью, составляет +24 — +26°С [2]. Холодовой фактор приводит к нарушениям ве гетативного статуса, проявляющихся вегетативным дисбалансом, в том числе, нарушениями ритма и элек трической проводимости сердца [4,5]. При гипотермии 30°С возникают: синусовая брадикардия, удлинение интервала PQ, комплекса QRS, интервала QT, инвер сия зубца T, появление зубца U, может развиться мер цательная аритмия, атриовентрикулярный узловой ритм, желудочковая тахикардия, смещение сегмента ST вверх и появление зубца Осборна — J wave, а при температуре 29°С — 28°C резко возрастает опасность развития фибрилляции желудочков сердца, которая может возникнуть не только в гипотермическом перио де, но и в процессе согревания [6, 7]
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