中国0至5岁儿童病因不明的急性发热诊断处理指南（简化版）

1体温测量 新生儿测体温应采用腋下电子体温计测体温（Ⅱa）；1个月至5岁儿童可采用腋下电子测温计或红外线测温仪测温（Ⅲ）；化学标点（相变）测温（额贴）方法不可靠，不主张采用（Ⅱa，Ⅱb）；口腔、直肠采用电子测温计测体温最为经济有效（Ⅱ）。     

体温计的发展与现状

一、前言体温测量的历史,可以上朔到16世纪。当时Santorio利用空气热膨胀的原理,制出了第一支测量口腔温度的体温计。本世纪初,开始用水银来制作体温计,至今在临床上得到了广泛的应用。根据1928年Ebstein的报告,当时除测量口腔及腋下的温度外,还可以测量直肠、颈部、大腿根部、外耳、阴道温度及尿温。这些都是用被测皮肤温度与玻璃球内积存的水银温度相等的原理实现     

利用电桥非平衡态对人体温度的测量

本文介绍一种通过半导体热敏换能材料与电桥非平衡态的结合来准确测量人体表皮温度的方法,其特点相比目前临床使用的水银式温度计,测温时间短,精度高,适宜推广应用。     

临床护士对水银体温计损坏危害认知的调查和分析

目的为了调查临床护士对水银体温计损坏危害知识情况.方法应用个案调查表对115名在职临床护士进行有关水银体温计破损后的现场处理及水银对人体的危害知识进行问卷调查.结果 34.8%临床护士对水银危害的重视程度不高;被调查者当中没人能正确处理破碎体温外溢的水银.结论建议学校和医院加强相关知识的教育,以减轻水银体温计破损所造成的职业危害.     

一种用于体温监测的数字探头

目的：体温是了解人体生理或病理状态的重要参数之一,目前国内大多数医院和家庭还是使用水银体温计和普通的电子温度计,水银温度计易碎、普通的电子温度计抗干扰能力较差,一般不适合体温的长时间监测。本文根据目前医院和家庭对体温长时间测量的要求,利用单片机技术设计了一种可用于医院和家庭长时间体温监测的数字探头。方法：该体温数字探头主要一片由美国微芯公司生产的PICl2LFl822单片机和一片低压差线性稳压器组成,PICl2LFl822单片机完成体温信号的采集、模数转换、数字信号处理和自动定时串口输出,低压差线性稳压器将上位机UART接口的5v电压转换为3V为PICl2LFl822单片机供电。结果：经过测量和测试表明：该体温数字探头的面积仅为80mm2、绝对误差小于0．2℃、工作电压在5V时数字探头的总功耗为0．8mW。该体温数字探头可完成除体温显示和超过上限温度报警之外的所有功能。结论：本文成功地设计出了一种可以在多参数监护仪等上位机使用的体温数字探头,该体温探头具有结构简单、成本低,精度高,抗干扰能力强、使用方便等优点。     

运动前后运动神经传导速度与体温、心率变化的相关分析

运动对神经传导速度的影响尚不十分清楚。本文观察了运动前后青年人胫神经MCV、体温、心率的变化,结果表明,一定运动后平均口温升高0.45℃,平均胫神经MCV增快5.11m/s,这与环境温度、体表温度对神经传导速度的影响有明显差异。应用多元回归方程分析发现,胫神经MCV变化与体内温度变化相关(r=0.4218,P<0.05),与心率变化无相关(r=0.0404,P>0.05)。运动引起运动神经传导速度增快,可能与运动本身及体温升高引起机体一些生理变化有关,它具有一定理论和应用价值。     

臂式电子血压计与水银血压计测量血压差异性研究

目的研究臂式电子血压计与水银血压计测得血压值的差异。方法随机选择113例住院患者,其中男性57例,女性56例;年龄23~74岁,平均年龄38.74岁。分别用臂式电子血压计和水银血压计按相同操作规程测量血压,比较两者所测血压值的差异,并对臂式电子血压计的重复性进行分析。结果臂式电子血压计与水银血压计测得的血压值差异无统计学意义[(14.93±2.40)k Pa/(9.33±1.54)k Pa vs(14.81±2.24)k Pa/(9.20±1.49)k Pa;P0.05)];臂式电子血压计重复性检测,收缩压、舒张压3次测量值两两比较,差异均无统计学意义(P0.05)。结论臂式电子血压计与水银血压计测得血压值相当,且臂式电子血压计更安全,具有良好的重复性,操作简单,便于携带,具有良好的应用前景。     

新型鼓膜红外测温系统的设计与运用

目的设计一种新型红外鼓膜测温系统,实现患者鼓膜温度的精确测量。方法系统包括外观结构设计、硬件电路设计和软件设计。采用红外温度传感器采集患者的红外辐射能量,通过数模转换将患者的温度显示在液晶显示器上,便于医务人员查看。新型红外测温系统采用BR70高精度黑体辐射源对其精确度和重复性进行测试,通过临床使用对其便携性和稳定性进行测试;确保鼓膜红外测温系统在不同的外界环境下能够保持测量的准确性。结果经过临床测试,该次设计的新型红外鼓膜测温系统温度准确度误差小于0.2℃,重复性误差小于0.2℃;人体工学设计的外观结构,使医务人员在使用过程中更加简便准确地测量鼓膜温度;系统的低功耗设计、自动休眠和按键唤醒功能,可以实现整个系统的更低功耗,延时系统的使用时间;采用一次性侦测耳套设计,提示医务人员每次测量需要更换一次性耳套,避免患者之间的交叉感染。结论新型红外鼓膜测温系统非常适合医务人员可以快速、精确地测量患者的体核体温,及时了解患者的身体状况,为患者的治疗和术后恢复具有重大意义。     

运动准备期间外耳道和面部温度的改变

为了研究剧烈运动之前大脑温度的升高 ,本文作者测量了外耳道 ( EAM)和面部温度。受试者全力的尽可能快的牵拉背部肌肉测量力计 ,并且在力量最大的位置保持 1 0 s。整个过程中受试者始终闭着眼睛。EAM温度由带红外光纤的红外热图仪测量。面部温度的红外热图仪测量一台实时记录仪每 0 .1 s记录一次热图像数据。额头 F7和 F8部位的EEG和右内侧腓肠肌的 EMG数据也同时用磁带做了记录。用由环境温度和受检者温度差计算得到的回归曲线将 EAM温度与体温进行标定。面部温度以 m2为单位计算。采用用实验室的快速傅立叶变换 ( FFT)程序分析了…     

基于蓝牙及手机平台的普适性体温无线监测及报警技术

传统的体温测量方式逐渐不能满足日常和临床需求,为实现对体温的长时监测和对疾病发作时的体温异常予以警示,本文研制出一种具有普适性的基于T型热电偶以及无线蓝牙通信模块的手机无线测温及记录模块,所实现功能可以方便、快捷地获取人体体表连续的温度信息并在温度发生异常时发出报警.性能测试实验不仅对比了记录卡与商用Agilent数据采集仪所测量的温度数值,还评估了其报警功能.结果 表明,记录卡能准确测量温度信息、实时将其发送至手机终端并实现海量数据存储;在设置一定报警阈值后,若将测温热电偶置于高于报警温度的温水中,手机会自动发出报警蜂鸣音.这种体温检测及报警技术提供了一种便捷、低成本的温度记录方式,在健康管理及医疗卫生行业有广泛用途.     

Validity of devices that assess body temperature during outdoor exercise in the heat

CONTEXT: Rectal temperature is recommended by the National Athletic Trainers' Association as the criterion standard for recognizing exertional heat stroke, but other body sites commonly are used to measure temperature. Few authors have assessed the validity of the thermometers that measure body temperature at these sites in athletic settings. OBJECTIVE: To assess the validity of commonly used temperature devices at various body sites during outdoor exercise in the heat. DESIGN: Observational field study. SETTING: Outdoor athletic facilities. PATIENTS OR OTHER PARTICIPANTS: Fifteen men and 10 women (age = 26.5 +/- 5.3 years, height = 174.3 +/- 11.1 cm, mass = 72.73 +/- 15.95 kg, body fat = 16.2 +/- 5.5%). INTERVENTION(S): We simultaneously tested inexpensive and expensive devices orally and in the axillary region, along with measures of aural, gastrointestinal, forehead, temporal, and rectal temperatures. Temporal temperature was measured according to the instruction manual and a modified method observed in medical tents at local road races. We also measured forehead temperatures directly on the athletic field (other measures occurred in a covered pavilion) where solar radiation was greater. Rectal temperature was the criterion standard used to assess the validity of all other devices. Subjects' temperatures were measured before exercise, every 60 minutes during 180 minutes of exercise, and every 20 minutes for 60 minutes of postexercise recovery. Temperature devices were considered invalid if the mean bias (average difference between rectal temperature and device temperature) was greater than +/-0.27 degrees C (+/-0.5 degrees F). MAIN OUTCOME MEASURE(S): Temperature from each device at each site and time point. RESULTS: Mean bias for the following temperatures was greater than the allowed limit of +/-0.27 degrees C (+/-0.5 degrees F): temperature obtained via expensive oral device (-1.20 degrees C [-2.17 degrees F]), inexpensive oral device (-1.67 degrees C [-3.00 degrees F]), expensive axillary device (-2.58 degrees C [-4.65 degrees F]), inexpensive axillary device (-2.07 degrees C [-3.73 degrees F]), aural method (-1.00 degrees C [-1.80 degrees F]), temporal method according to instruction manual (-1.46 degrees C [-2.64 degrees F]), modified temporal method (-1.36 degrees C [-2.44 degrees F]), and forehead temperature on the athletic field (0.60 degrees C [1.08 degrees F]). Mean bias for gastrointestinal temperature (-0.19 degrees C [-0.34 degrees F]) and forehead temperature in the pavillion (-0.14 degrees C [-0.25 degrees F]) was less than the allowed limit of +/-0.27 degrees C (+/-0.5 degrees F). Forehead temperature depended on the setting in which it was measured and showed greater variation than other temperatures. CONCLUSIONS: Compared with rectal temperature (the criterion standard), gastrointestinal temperature was the only measurement that accurately assessed core body temperature. Oral, axillary, aural, temporal, and field forehead temperatures were significantly different from rectal temperature and, therefore, are considered invalid for assessing hyperthermia in individuals exercising outdoors in the heat.     

Patient monitoring during and after open heart surgery by an improved deep body thermometer

The deep body thermometer developed by Fox was improved by Togawa by thermal insulation of the probe. The present status of medical progress in clinical thermometry through the improved deep body thermometer was reviewed from the view point of cardiac surgery. The forehead and sole temperatures obtained by this improved thermometer were monitored and recorded by a multipotentiometric recorder continuously up to 12 days in the patients admitted to the ICU who underwent open heart surgery. The forehead tissue temperature measured by this thermometer is slightly lower than and parallel to the rectal temperature, being close to the pulmonary arterial blood temperature. On the other hand, the sole tissue temperature fluctuates from room temperature to the forehead tissue temperature, sometimes showing rhythmic changes. The former seems to be the core temperature and the latter, the shell temperature. The dissociation when the two temperatures are more than 7 degrees C apart from each other suggests that the hemodynamical condition is worse than in the convergence when they remain within 2 degrees C. A state of shock can be diagnosed when the arterial systolic pressure is less than 90 mmHg and the urine output less than 1 ml/min/mg in addition to the dissociation. The effect of treatment and the prognosis for the patient are predictable according to the trends of the two temperatures as divergent or convergent. The dynamic thermometry by this thermometer is very informative and the procedure is noninvasive without discomfort to the patient.     

Measuring the body temperature: how accurate is the Tempa Dot?

INTRODUCTION: We evaluated the accuracy of a disposable, sterile thermometer that is practical in use and holds no risk of cross-infections. METHODS: a cross-sectional study was set up in which we compared the Tempa Dot with the mercury thermometer in adults and children. Subjects were recruited from general practice and a paediatric ward. The mercury thermometer was used orally in subjects over 2 years of age and rectally in children up to 2 years old. The Tempa Dot was used either orally or axillary. RESULTS: The total population consisted of 212 patients, of which 131 children were younger than 16 years old. Their mean age was 17.3 years old, ranging from 1 month to 76 years. The mean difference between the mercury thermometer and the Tempa Dot, used orally or axillary, was 0.04 degrees C. For children between 0 and 16 years old, the mean difference was 0.08 degrees C. Agreement between the two methods as assessed with regression analysis and Bland and Altman plots was very good. ROC curve analysis suggests cut-off points of 37.2 and 37.6 degrees C to detect fever for the Tempa Dot at the oral and the axillary site respectively. Sensitivity and specificity were 100.0% and 79.0% for the total population, measuring orally and 100.0% and 95.9% axillary. In children, sensitivity and specificity were 100.0% and 83.1% orally, and 100.0% and 95.4% axillary. Using a single cut-off point for both measuring sites, namely 37.5 degrees C, sensitivity dropped and specificity increased for the oral site. For the axillary site, sensitivity remained unchanged and specificity was somewhat less. CONCLUSION: the Tempa Dot is a reliable alternative for the mercury thermometer. In clinical use, a cut-off point of 37.5 degrees C for both the oral and axillary site is most appropriate.     

Development of a continuous temperature mapping system using a deep body thermometer

To determine continuous body temperature distribution, an inexpensive temperature mapping system was developed using a deep body thermometer adopting the finite-element method. A stripe with 16 thermocouples was wrapped around the waist of rats to measure body surface temperatures (the boundary conditions). The abdominal deep temperature of the rats was measured from the dorsum using the thermal compensation probe of a deep body thermometer. The abdominal temperature of the rats was mapped by solving a heat conduction equation using surface and deep temperatures obtained in real time. The temperature measured with a thermocouple inserted into the abdominal centre of the rats correlated well with the calculated temperature (r = 0.93, p < 0.01). The system is low cost and simple to use compared with the magnetic resonance temperature mapping system. Our temperature mapping system could potentially result in improved management of patients in critical care medicine.     

Infrared cameras are potential traceable “fixed points” for future thermometry studies

Abstract

The National physical laboratory (NPL) requires “fixed points” whose temperatures have been established by the International Temperature Scale of 1990 (ITS 90) be used for device calibration. In practice, “near” blackbody radiators together with the standard platinum resistance thermometer is accepted as a standard. The aim of this study was to report the correlation and limits of agreement (LOA) of the thermal infrared camera and non-contact infrared temporal thermometer against each other and the “near” blackbody radiator. Temperature readings from an infrared thermography camera (FLIR T650sc) and a non-contact infrared temporal thermometer (Hubdic FS-700) were compared to a near blackbody (Hyperion R blackbody model 982) at 0.5?°C increments between 20–40?°C. At each increment, blackbody cavity temperature was confirmed with the platinum resistance thermometer. Measurements were taken initially with the thermal infrared camera followed by the infrared thermometer, with each device mounted in turn on a stand at a fixed distance of 20?cm and 5?cm from the blackbody aperture, respectively. The platinum thermometer under-estimated the blackbody temperature by 0.015?°C (95% LOA: ?0.08?°C to 0.05?°C), in contrast to the thermal infrared camera and infrared thermometer which over-estimated the blackbody temperature by 0.16?°C (95% LOA: 0.03?°C to 0.28?°C) and 0.75?°C (95% LOA: ?0.30?°C to 1.79?°C), respectively. Infrared thermometer over-estimates thermal infrared camera measurements by 0.6?°C (95% LOA: ?0.46?°C to 1.65?°C). In conclusion, the thermal infrared camera is a potential temperature reference “fixed point” that could substitute mercury thermometers. However, further repeatability and reproducibility studies will be required with different models of thermal infrared cameras.     

Development of a new method for the noninvasive measurement of deep body temperature without a heater

The conventional zero-heat-flow thermometer, which measures the deep body temperature from the skin surface, is widely used at present. However, this thermometer requires considerable electricity to power the electric heater that compensates for heat loss from the probe; thus, AC power is indispensable for its use. Therefore, this conventional thermometer is inconvenient for unconstrained monitoring. We have developed a new dual-heat-flux method that can measure the deep body temperature from the skin surface without a heater. Our method is convenient for unconstrained and long-term measurement because the instrument is driven by a battery and its design promotes energy conservation. Its probe consists of dual-heat-flow channels with different thermal resistances, and each heat-flow-channel has a pair of IC sensors attached on its top and bottom. The average deep body temperature measurements taken using both the dual-heat-flux and then the zero-heat-flow thermometers from the foreheads of 17 healthy subjects were 37.08 °C and 37.02 °C, respectively. In addition, the correlation coefficient between the values obtained by the 2 methods was 0.970 (p < 0.001). These results show that our method can be used for monitoring the deep body temperature as accurately as the conventional method, and it overcomes the disadvantage of the necessity of AC power supply.     

Laboratory and hospital testing of new infrared tympanic thermometers

A patented approach to infrared thermometry based on the use of a standard pyrosensor has resulted in the development of two new infrared tympanic thermometers, one for professional use, the other for home use. Both were tested to evaluate accuracy in the laboratory and to evaluate equivalence to standards, correlation to standards, and precision in human subjects. Accuracy was found to be well within ASTM standards on both models. Mean ear temperatures were 0.2 degrees C below oral and 0.7 degrees C below bladder temperature. Correlations between ear and oral and ear and bladder temperatures were r = .77 to .84. Repeatability in the same ear was very high at r = .95 (left) and .97 (right). Reproducibility between left and right ear ranged from r = .89 to .92.     

The vagaries of ear temperature assessment

There have been a growing number of reports suggesting that ear temperature measurement is unreliable and by implication so is the device. Examination of the measurement site, the tympanic membrane (eardrum) and the walls of the external auditory meatus (ear canal) reveals that at least some of the unreliability might derive from poor aiming of the infrared thermometer: the ear canal walls have a lower temperature than the eardrum. Additionally, anatomical properties of the ear canal may increase the difficulty of aiming the thermometer at the eardrum. Furthermore, the rich vascularization, innervation and variations in skin properties (thickness, oil secretion and hair) along the length of the ear canal affect the black body-like nature of the structure. It is concluded that such factors are more likely underlying reasons for the difficulties in reliably reproducing temperatures from this site. We conclude that concerns should extend beyond the reliability of the device and there should be greater study of the measurement site. The argument extends to all sites chosen for clinical assessment of the patient, as previous studies of the alternative temperature measurement sites are also unfortunately few and tend to be lacking in scientific rigour.     

The vagaries of ear temperature assessment

There have been a growing number of reports suggesting that ear temperature measurement is unreliable and by implication so is the device. Examination of the measurement site, the tympanic membrane (eardrum) and the walls of the external auditory meatus (ear canal) reveals that at least some of the unreliability might derive from poor aiming of the infrared thermometer: the ear canal walls have a lower temperature than the eardrum. Additionally, anatomical properties of the ear canal may increase the difficulty of aiming the thermometer at the eardrum. Furthermore, the rich vascularization, innervation and variations in skin properties (thickness, oil secretion and hair) along the length of the ear canal affect the black body-like nature of the structure. It is concluded that such factors are more likely underlying reasons for the difficulties in reliably reproducing temperatures from this site. We conclude that concerns should extend beyond the reliability of the device and there should be greater study of the measurement site. The argument extends to all sites chosen for clinical assessment of the patient, as previous studies of the alternative temperature measurement sites are also unfortunately few and tend to be lacking in scientific rigour.