连续性肾脏替代治疗温度管理的范围综述

doi:10.3761/j.issn.2096-7446.2026.10.020

摘要/Abstract

摘要：

目的探讨连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）期间患者体温变化的趋势、低体温的危险因素及干预措施，评估不同温度设定对体温的潜在影响，构建CRRT温度管理的整体框架。方法依据范围综述研究框架，系统检索Web of Science、PubMed、Cochrane Library、Embase、Ovid、中国知网、维普数据库、万方数据库，检索时限为建库至2024年11月22日。根据纳入及排除标准对文献进行筛选、汇总、提取、分析。结果共纳入38篇文献，发现CRRT患者体温在治疗的最初12 h呈下降趋势，前4 h降幅最为显著。低体温的危险因素包括休克、高龄、液体平衡失调、使用血管活性药物、较高的重症评分、较长的CRRT治疗时长、治疗模式与剂量，以及CRRT加热方式。保护性因素包括体重、平均动脉压和基础体温。目前，针对低体温的干预措施包括加热置换液、充气升温机和预热液体，其中充气升温机保温效果良好。结论 CRRT患者治疗期间体温在初期呈下降趋势，随后趋于稳定，并在治疗后逐渐回升。建议针对高风险患者在治疗初期2~4 h内实施个体化保暖干预，合理选择设备和加热方式。未来研究可进一步明确温度设定与治疗时长的交互效应在预防CRRT早期低体温与低血压中的作用，尤其关注机械通气等特定亚组的干预时机与适应性，从而优化温度管理策略。

关键词: 连续性肾脏替代治疗, 温度管理, 低体温, 范围综述, 循证护理学

Abstract:

Objective To explore body temperature trends during continuous renal replacement therapy（CRRT），identify hypothermia risk factors and preventive strategies，assess the effects of varying temperature settings on thermoregulation，and propose an integrated temperature management framework for CRRT. Methods Following a scoping review approach，we systematically searched Web of Science，PubMed，Cochrane Library，Embase，Ovid，CNKI，VIP，and Wanfang databases.The retrieval time limit was from the establishment of the database to November 22，2024. Eligible articles were screened，summarized，extracted，and synthesized according to inclusion and exclusion criteria. Results A total of 38 studies were included. The findings indicated that body temperature in CRRT patients showed a declining trend during the initial 12 hours of treatment，with the most significant drop occurring within the first 4 hours. Risk factors for hypothermia included shock，advanced age，fluid imbalance，use of vasoactive agents，higher severity scores，prolonged CRRT duration，treatment modality and dose，and the type of heating method used during CRRT. In contrast，protective factors included higher body weight，higher mean arterial pressure（MAP），and higher baseline body temperature. Preventive strategies primarily included heating replacement fluids，using forced-air warming devices，and preheating infusions，with forced-air warming devices showing comparatively better thermal maintenance. Conclusion During CRRT，patients’ body temperature typically shows an initial decline，gradually stabilizes，and eventually recovers after treatment. Therefore，it is recommended to implement individualized warming interventions for high-risk patients within the first 2-4 hours of therapy and to select optimal warming devices and techniques. Future research should clarify the role of the interaction effect of temperature setting and treatment duration in preventing hypothermia and hypotension in the early stage of CRRT，especially focusing on the intervention timing and adaptability of specific subgroups such as mechanical ventilation，so as to optimize the temperature management strategy.

Key words: Continuous Renal Replacement Therapy, Temperature Management, Hypothermia, Scoping Review, Evidence-Based Nursing

郁禛元, 张钰琳, 袁金晶, 顾紫昕, 唐欢, 沈永红. 连续性肾脏替代治疗温度管理的范围综述[J]. 中华急危重症护理杂志, 2026, 7(10): 1272-1280.

YU Zhenyuan, ZHANG Yulin, YUAN Jinjing, GU Zixin, TANG Huan, SHEN Yonghong. Temperature management in continuous renal replacement therapy：a scoping review[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(10): 1272-1280.

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