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使用红外线鼓膜温度计测量鼓膜温度的准确性
摘要
背景：在调查和诊断病人时，准确的测量温度是非常重要的。鼓膜温度测量的优点是速度快、安全性和易用性。本研究的目的是比较红外鼓膜温度计与水银温度计测量体温的准确性。
方法: 2012年10月在苏丹的恩图曼医院，使用汞玻璃温度计和红外线鼓膜的温度计对病人的腋和鼓膜温度连续同步的测量。
结果:总的来说，在174例患者的温度测量中，95人(54.6%)是男性。病人平均(SD)年龄和体重是33.18(25.07)年和52.13(69.85)公斤。在水银和红外线鼓膜温度计(SD)温度测量中，没有明显的不同，水银温度计测出是37.29°C(0.91)，P = 0.373，鼓膜的腋窝体温测量出是与37.38°C(0.95)，有显著的正相关关系。两个读数的平均差异是- 0.093(?0.20)0.02°C。
结论:在这项研究中，相对于水银玻璃温度计，鼓膜温度测量是可靠和准确的。因此，鼓膜的温度测量可以用于临床实践，特别是在紧急情况，在易用性和速度获得温度读数是重要的。
关键词：鼓膜，腋温，苏丹，红外，温度测量
背景
测量体温是最古老的已知的诊断方法，在日常生活中的医疗护理[1]，它是一个健康与疾病的指标。苏丹流行着许多传染性疾病，如疟疾，这需要快速、安全、准确的温度测量来筛查发烧的病人。人体温度有所不同，实际上是不超过一个近似的温度值，估计集成在中枢神经系统内众多的热输入，包括脊髓、神经鞘。在中脑网状结构，和迷走神经，最后抵达哺乳动物的体温调节的控制器下丘脑。自主体温调节的控制有五个主要的
贡献者，皮肤表面，深腹部和胸部组织，脊髓、下丘脑和其他部分大脑。尽管温度测量肺动脉导管，代表核心体温，这个方法是有侵入性的，不适合大多数病人。腋窝的温度测量是一种非侵入性的技术体现了身体温度和与直肠温度。使用水银温度计，尤其是玻璃水银温度计并非没有危险。
图1是比较腋和鼓膜的身体温度测量：
图1 腋和鼓膜的身体温度测量(°C)
红外线鼓膜温度计是理想的，因为鼓膜是分享同一个始发于颈动脉下丘脑供应的动脉血液。因此，鼓膜的膜被认为直接反映核心温度[10]。红外线鼓膜温度计容易使用是潜移默化的，在传统的技术中是保证精度的温度计(11、12)。一些数据可以反应鼓膜温度计的准确性。因此，目前的目的是研究比较鼓膜温度计的温度，以便用来与汞玻璃温度计之前获得的温度进行比较。
方法
病人选择：
本研究旨在调查恩图曼教学医院，在2012年10月的苏丹，用包括两个成人和1岁以上的儿童的病人，观察有或没有发烧，在此期间将其列入研究进行了评估。患者被便利抽样(基于双向假说测试使用Epiinfo与80%的动力和信心间隔的95%)，直到同时腋窝和鼓膜温度测量得到。那些外耳炎、软组织感染，严重的疾病的情况下，那些戴着助听器和那些不愿参加这项研究被排除在外。这项研究是由伦理委员会批准恩图曼医院，得到书面同意从所有的病人或从儿童监护人中实验。
仪器：
一个布劳恩(红外热成像4520，布劳恩GmbH是一家现代化的、Kronberg、德国)，设备被用来验证之前的研究[13]，其被用于红外测量鼓膜温度。一个非自身调整水银式温度计是用来测量腋温度。所有的水银温度计是校准设定在38°C。只有那些温度计与偏差小于0.1°C才能用于这项研究。所有患者检查到的耳部感染，排除阻塞耳蜡清除。使用同样的程序来测量右耳鼓膜温度。
图2 红外线鼓膜的体温和水银玻璃温度计的散点图的相关性
过程
一个医疗官和三个护士接受培训，然后正确使用所有温度测量装置。患者完成了研究他们的腋下和鼓膜的标准膜的温度，同时测量在08.00 h。探测器的红外辐射温度计插入到外耳道通过将耳廓向后，并指挥探头向前。探测器是处于同一种姿势直到听到响声。水银式温度计动摇了在每个温度读数低于35°C的记录，然后放置在患者的腋下，最低的保持5分钟。然后相同的医疗工作者将读取和记录。从鼓膜和水银式温度计中数字阅读比较。然后，另一个研究团队的成员将阅读水银温度计的文档，失真的结果交予原来的医疗工作者。
数据分析
分析实验结果用Windows(SPSS公司，芝加哥，美国)SPSS 20.0版。线性correla——对其进行对比腋和鼓膜的特点。数据集之间的差异被绘制为的奥特曼图表[14]。基于以前
预定义的临床可接受的限度，二层鼓膜和腋窝的测量方法是意味着标准差是在±0.2°C。
结果
一般特性：温度测量了174例(67。38.5%是孩子< 18年)，在医学情况相同情况下，有95(54.60%)男性，他们的平均年龄(SD)是30.1(24.1)年(范围2 - 80年)和平均重量(SD)是54.4(69.8)公斤。同样的女性，平均年龄(SD)为32.4年(范围2 - 80)和平均重量(SD)是56.1(62.7)公斤。这些174患者，61例(35.1%)患者发热(温度> 37.5°C)根据两腋和鼓膜的读数如图3：
图3 不同的红外测温法和水银玻璃鼓膜的温度测量
腋的体温与鼓膜的身体温度平均(SD)体温测量分别是37.29(0.91;腋)和37.38(0.95;鼓膜的)，P = 0.373°C。有一个正相的关系，身体温度使用腋和鼓膜的方法(r = 0.697，P < 0.001)两个人之间的读数差是?0.093(?0.20)0.02°C。
讨论
当前主要目的是研究腋和鼓膜的测量体温方法。本研究，问题是在标准腋下温度的测量方法下，如何做鼓膜的膜温度测量，或可以新设备代替旧的吗?红外线鼓膜温度计拿什么来衡量鼓膜的膜的红外热辐射。然而，已经表达了对鼓膜温度测量的准确性的怀疑(16、17)和差异。已经观察到当测量由两个耳朵，耳朵感染的鼓膜时，如中耳炎可以影响真实的温度鼓膜[18]。进一步研究比较直肠温度测量与红外线鼓膜的温度计测量没有发
现相同点。
最后的结果，目前的研究得到的与Chueetal相比。2011年泰缅边境,来自口头上的水银温度计的恐慌，发现意味着在这两种设备的缺席下，所有观察设备0.09°C(95%置信区间:0.07—-0.12)[10]，不止一个被Chueetal阅读使用。同样，拉巴尼在2010得出同样的结论，尤其是在年轻的病人，两鼓膜和口腔温度记录，以及把口腔温度作为标准。然而与2011年相比，红外线鼓膜温度计在口头方式与卷曲玻璃温度计读数测量温度在不到5岁的发热和无热的孩子，发现平均温度相差0.41±0.37°C(P < 0.001)和0.47±0.39发热组°C(P < 0.001)。尽管鼓膜的膜的温度有相当好的灵敏度和特异性，该研究得出结论说，当测量孩子们的体温时，他们可能不是可靠的估计。
从目前的研究结果中看，因为他们安全，易于使用和快速获取温度读数，所以支持使用红外鼓膜温度计。此外，汞的危害毒性使得红外温度计更加可取带老式汞玻璃温度计，基于他们的低成本，相比鼓膜温度计，有些则可能更喜欢后者。有一个限制是使用目前的研究腋窝温度作为测量的核心温度而不是肛。其是易于使用，通常用于我们的设置和可能接受的传统和习俗此设置。但衡量这要求的核心温度最好与肺动脉温度相关。
这种侵入性的程序，是不适合使用在紧急护理实践中的。此外，本研究不包括患者体温过低，所以它的发现不能外推到新生儿或与低体温的病人。进一步的研究必须包括这些，组织应支持实施更广泛的使用鼓膜温度计。
结论
在这项研究中，鼓膜温度的测量一样可靠的准确的。因此，鼓膜温度测量可以在临床实践中使用，因为它很容易使用和获得的快读的温度读数。
作者细节
1.大学医学院，卡西姆大学，卡西姆，沙特阿拉伯。
2. buraidah中心医院，Buraidah、沙特阿拉伯。
3.教师大学医学院喀土穆，邮政信箱102，喀土穆，苏丹。
收到:2013年3月14日:2013年5月9日接受
发表:2013年5月10日
英文文献来源：Gasim I Gasim, Imad R Musa, Mohamed T Abdien, Ishag Adam in BMC Research Notes (2013)
Accuracy of tympanic temperature measurement
using an infrared tympanic membrane thermometer
Abstract
Background: During investigation and diagnosis of patients, accurate temperature measurement is of great importance. The advantages of tympanic membrane thermometry are speed (temperature reading available within seconds), safety, and ease of use. The aim of this study was to compare the accuracy of infrared tympanic thermometers in comparison to mercury thermometers in measurement of body temperature. Methods: Axillary and tympanic temperature was measured simultaneously in consecutive patients using mercury glass and infrared tympanic thermometers at Omdurman Hospital, Sudan during October 2012.Results: In total, temperature was measured in 174 patients, 95 of whom (54.6%) were male. The mean (SD) patient age and weight was 33.18 (25.07) years and 52.13 (69.85) kg. There was no significant difference in mean (SD) temperature measurement between mercury and infrared tympanic membrane thermometers, 37.29°C (0.91) versus 37.38°C (0.95), P = 0.373, respectively. There was a significant positive correlation between axillary and tympanic body temperature measurements (r = 0.697, P < 0.001). The mean difference between the two readings (with limits of agreements) was - 0.093 (?0.20; 0.02) °C.
Conclusion: In this study, tympanic membrane thermometry is as reliable and accurate as axillary mercury glass thermometry. Thus, tympanic thermometry can be used in clinical practice, especially in the emergency setting, where ease of use and speed of obtaining the temperature reading are important.
Keywords: Tympanic membrane, Axillary temperature, Sudan, Infrared, Thermometry Background:
Measurement of body temperature is one of the oldest known diagnostic methods and still remains an import-ant indicator of health and disease, both in everyday life and in medical care [1]. Sudan has endemic levels of many communicable diseases, such as malaria [2,3],which necessitate speedy, safe and accurate temperature measurement for screening for fever.
Body temperature depends on the type of thermometer and the area of the body used for
taking the measurement [4]. Human body temperature varies depending on the site from which the reading was taken - these differences are actually no more than an approximation of the true value that is being estimated [4,5]. Integration.
Table 1 Comparison of axillary and tympanic body
Infrared tympanic membrane thermometers are considered ideal because the tympanic membrane and the hypothalamus share an arterial blood supply originating from the carotid artery; therefore, the tympanic membrane is considered to directly reflect core temperature[10]. An infrared tympanic membrane thermometer is easy to use and is favored over a conventional mercury thermometer provided its accuracy is guaranteed [11,12]. Few published data are available on the accuracy of tympanic membrane thermometers. Thus, the aim of the current study was to compare the temperature obtained by tympanic membrane thermometers with that obtained with mercury glass thermometers before recommending tympanic thermometers for use in general practice in Sudan.
Methods:
Patient selection
This study was conducted at Omdurman Teaching Hospital, Sudan during October 2012. Patients including both adults and children above one year of age, presenting with or without fever to the emergency room during this period were evaluated for inclusion in the study. Patients were recruited by convenience sampling (based on a 2-sided hypothesis tests using Epiinfo with 80% power and confidence interval of 95%) until 174 sets of simultaneous axilla and tympanic membrane temperature measurements were obtained. Those with otitis externa/media, soft tissue infection, severe illness, trauma patients, those who had had a cold or hot drink or who had smoked in the 20 minutes prior to examination, those wearing a hearing aid and those who were unwilling to be enrolled in the study were excluded. The study was approved by the ethical committee at Omdurman Hospital, and written consent was obtained from all patients or from a guardian for children.
Instruments
A Braun ThermoScan (IRT 4520, Braun GmbH, Kronberg, Germany), a device validated in a previous study [13], was used for the infrared measurement of tympanic membrane temperature. A non-self-adjusted mercury bulb thermometer was used to measure axillary temperature. All the mercury bulb thermometers were calibrated in a single water bath set at 38°C. Only those thermometers with a deviation of less than 0.1°C were used for the study. All patients were examined otoscopically to exclude ear infection and occluding ear wax was cleared. The same procedure using the right ear right was used to measure the tympanic membrane temperature for each patient.
Procedure
A medical officer and three nurses received training on the proper use of all temperature measuring devices.Their visual acuity in both eyes tested 6/6. Patients who fulfilled the study criteria had their axilla and tympanic membrane temperatures simultaneously measured at 08.00 h. The probe of the infrared thermometer was inserted into the external auditory meatus by pulling the pinna backward, and directing the probe towards the eye. The probe was held in the same position until the beep was heard. The mercury bulb thermometer was shaken before
each recording to decrease its temperature reading to below 35°C and then placed, for a minimum of 5 minutes, in the patient’s axilla. The same healthcare worker would read and document the digital reading from the tympanic membrane thermometer and the mercury bulb thermometer. Immediately, another member of the team would then read and document the mercury thermometer, blinded from the results of the original healthcare worker.
Statistical analyses
The results were analyzed using SPSS, version 20.0 for Windows (SPSS Inc, Chicago, IL, USA). Linear correlations were made between tympanic and axillary temperatures. Differences between sets of data were plotted as described by Bland-Altman [14]. Based on previously pre-defined clinically acceptable limits, agreement between tympanic and axillary measurement methods was accepted when the mean ±2 standard deviations was within ±0.2°C [15].
Result
General characteristics
Temperature was measured for 174 patients (67; 38.5% were children < 18 years), all of whom were medical cases. There were 95 (54.60%) males, their mean age (SD) was 30.1 (24.1) years (range 2–80 years) and mean weight (SD) was 54.4 (69.8) kg. likewise for the females, the mean age (SD) was 32.4 years (range 2–80) and the mean weight (SD) was 56.1(62.7) kg. Out of these 174 patients, 61 (35.1%) patients were febrile (temperature>37.5°C) according to both axillary and tympanic readings. Axillary body temperature versus tympanic body temperature The mean (SD) body temperature measurements were 37.29 (0.91; axillary) and 37.38 (0.95; tympanic),P = 0.373°C (Table 1). There was a positive correlation between body temperature using axillary and tympanic methods (r = 0.697, P < 0.001; Figure 1). The mean difference, with limits of agreements, between the two readings was ?0.093 (?0.20; 0.02) °C (Table 2 and Figure 2).
Discussion
The main finding of the current study was a positive correlation between axillary and tympanic methods of measuring body temperature. This study positively answered the question ‘How well does tympanic membrane temperature measurement agree with standard axillary measuring technique?’, or can the new device substitute for the old? Infrared tympanic membrane thermometers take seconds to measure the natural emission of infrared thermal radiation from the tympanic membrane. However, doubts have been expressed about the