胆道外科患者核心体温围术期全流程智能监测系统的构建与应用

目的 探索胆道外科手术患者核心体温围术期全流程智能监测方法,为围术期体温监护创新提供实证方案。方法 在胆道外科病房及麻醉手术中心建设基于穿戴式无线体温传感器的智能体温监测系统,对手术患者实施围术期全流程连续体温监测。结果 2019年10月至2021年7月共监测胆道外科手术患者3 383例,与仅监测术中体温相比,围术期监测到更多低体温事件(35.74%vs.44.37%)、更低的体温最低值(36.13℃vs.35.98℃)、更大的体温跌幅(0.29℃vs. 0.47℃)、更长的低体温时间(81.00 min vs.165.00 min),均P<0.05。结论 患者核心体温围术期全流程智能监测可实现围术期全程体温监测,真实、动态、连贯地反映患者围术期体温变化,有助于指导精准、个体化的围术期体温管理。     

肿胀液温度对吸脂术后受术者核心体温的影响

目的 探讨肿胀液温度对吸脂术后受术者核心体温的影响.方法 15例健康女性随机分为A、B两组,A组8例,肿胀液温度为室温25 ℃;B组7例,肿胀液温度为37 ℃.15例手术均采取硬膜外麻醉.统计分析术后0、1、2、3、4、8 h两组核心体温、呼吸频率、脉率和血压的差异.结果 A组术后0、1、2、3 h核心体温分别为(35.8±0.5)℃、(35.8±0.5)℃、(36.0±0.5)℃、(36.1±0.5)℃,B组为(36.5±0.4)℃、(36.5±0.3)℃、(36.5±0.3)℃、(36.6±0.4)℃,两组比较差异有统计学意义(P=0.008,P=0.008,P=0.03,P=0.033).两组术后4、8 h体温差异无统计学意义(P>0.05).两组受术者的呼吸频率、脉率和平均动脉压术后各时相点差异均无统计学意义(P>0.05).结论 吸脂术中应用低温肿胀液易导致受术者核心体温降低,增加手术风险,不利于术后康复.术中应用37 ℃的肿胀液是值得提倡的.     

经尿道电切术中不同温度冲洗液对心血管系统的影响

目的　探讨经尿道手术中不同温度冲洗液对心血管系统的影响。　方法　 87例经尿道电切手术患者随机分为两组 ,分别应用低温和等温冲洗液 ,监测冲洗液温度对中心体温、生命体征和心功能的影响。　结果　低温冲洗液组 48例术中体温平均下降 2 .1℃ ,平均动脉压升高 ,心排出量下降 ,系统血管阻力增加 ;等温冲洗液组 39例术中体温下降 0 .3℃ ,心功能稳定 ,生命体征平稳。　结论　低温冲洗液可导致体温下降 ,降低心排出量和显著增加系统血管阻力 ,增加老年患者心血管并发症的危险性 ,而等温冲洗液则可有效维持心功能的稳定 ,提高经尿道手术的安全性。     

深低温停循环大血管手术患者术中温度控制

目的探讨深低温停循环下大血管手术患者的术中温度控制方法。方法对121例深低温停循环大血管手术患者,在停循环与恢复循环期间进行核心体温、环境温度监测与控制,同时做好低温下患者皮肤防护。结果 121例手术患者停循环期核心体温控制在25.42~25.68℃,循环恢复后核心体温控制在36.41~36.50℃,停循环环境温度控制在18.50~18.68℃,循环恢复后环境温度控制在23.44~23.70℃,温度指标控制良好;耳廓及面部等周围皮肤无冻伤,骶尾、足底受压部位皮肤发生压红9例,术后未发生压疮。结论综合降温和综合保温措施是保障深低温停循环下大血管手术患者核心体温和环境温度有效管理的方法。     

围术期体温保护研究进展

围术期低体温可引起多种严重并发症,手术期间应连续监测体温并使用积极的保温措施,术后应对体温进行评估.重视体温保护在临床应用中有广阔的前景,对它的研究是近年来的热点,现就近几年关于体温保护方面的研究进展作一简要综述.     

围术期体温保护研究进展

围术期低体温可引起多种严重并发症,手术期间应连续监测体温并使用积极的保温措施,术后应对体温进行评估.重视体温保护在临床应用中有广阔的前景,对它的研究是近年来的热点,现就近几年关于体温保护方面的研究进展作一简要综述.     

围术期体温保护研究进展

围术期低体温可引起多种严重并发症,手术期间应连续监测体温并使用积极的保温措施,术后应对体温进行评估.重视体温保护在临床应用中有广阔的前景,对它的研究是近年来的热点,现就近几年关于体温保护方面的研究进展作一简要综述.     

不同温度灌洗液对输尿管软镜下钬激光碎石术后寒战及炎性反应的影响分析

目的探讨等体温(37 ℃)、等室温(24 ℃)及冷液体(20 ℃)3种温度的灌洗液对输尿管软镜下钬激光碎石术后寒战及炎性反应的影响。方法选取连云港市第二人民医院2020年7月—2023年7月收治的132例接受输尿管软镜下钬激光碎石术患者的病历资料, 根据术中灌洗液温度分为冷液体组(20 ℃, n=44)、等室温组(24 ℃, n=44)和等体温组(37 ℃, n=44), 采用方差分析三组手术10 min、30 min、术毕即刻核心体温、手术前后应激反炎性反应, 采用χ2检对比三组术后寒战发生情况。结果三组患者手术10 min、30 min、术毕即刻核心体温对比差异具有统计学意义, 冷液体组上述时间点核心体温较等室温组、等体温组低(P<0.05), 而等室温组和等体温组术中10 min、30 min、术毕即刻核心体温对比差异无统计学意义(P>0.05);三组术后甲肾上腺素、血清皮质醇水平较术前升高, 冷液体组较等室温组和等体温组高(P<0.05), 但等室温组和等体温组两组术后对比差异无统计学意义(P>0.05);三组术后C反应蛋白、白细胞介素-10、白细胞水平...     

保温对全麻唤醒手术患者寒战躁动及术中苏醒的影响

目的探讨保温对术中唤醒全麻手术患者寒颤和躁动发生率、失血量、术中和术后苏醒时间及术后住院时间的影响。方法将70例行术中唤醒全麻手术患者随机分成对照组与观察组各35例。对照组行常规体温处理,即棉被覆盖保暖,输入液体及冲洗液加温;观察组在此基础上加用保温毯。围手术期对患者进行直肠温度监测,对两组寒战、躁动、失血量、术中苏醒时间、术后苏醒时间、拔除喉罩时间及术后住院时间进行记录。结果观察组术中核心体温及低体温、寒战、躁动发生率,失血量、术中苏醒时间及术后住院时间显著低于或短于对照组(P0.05,P0.01)。结论围手术期保温能够降低患者寒战、躁动发生率,减少失血量,缩短术中苏醒和术后住院时间。     

围术期低体温有效预防策略的研究进展

正人体正常体温调节系统由温度感受器、体温调节中枢及效应器三部分组成。人体核心体温受严密调控维持在37 ℃左右,外周体温较核心体温低2～4 ℃。与有目的的治疗性低体温不同,非医疗计划导致的围术期机体核心体温低于36.0 ℃称为围术期意外低体温(inadvertent perioperative hypothermia, IPH)[1],又称围术期低体温。IPH在各类手术中发生率为7%～90%[1-2],可导致心血管事件[3]、术后感染[4]、     

Temperature monitoring and management during neuraxial anesthesia: an observational study

Temperature monitoring and thermal management are rare during spinal or epidural anesthesia because clinicians apparently restrict monitoring to patients with an expected risk of hypothermia. This implies that anesthesiologists can predict patient thermal status without monitoring core temperature. We therefore, tested the hypotheses that during neuraxial anesthesia: 1) amount of core hypothermia depends on the magnitude and duration of surgery; 2) temperature monitoring and thermal management are used selectively in patients at high risk of hypothermia; and 3) anesthesiologists can estimate patient thermal status. We evaluated thermal status on arrival in the recovery room along with intraoperative thermal management and monitoring in 120 patients. Anesthesiologists were asked if their patients were hypothermic (<36 degrees C). There was no correlation between the magnitude or duration of surgery and initial postoperative core temperature in unwarmed patients. Temperature monitoring and thermal management were not used selectively in high-risk patients. Initial postoperative tympanic membrane temperatures were <36 degrees C in 77% of patients and <35 degrees C in 22%. Body temperature was monitored intraoperatively in 27% of the patients and forced-air warming was used in 31%. Anesthesiologists failed to accurately estimate whether their patients were hypothermic. Our results suggest that temperature monitoring and management during neuraxial anesthesia is currently inadequate. IMPLICATIONS: In this observational study, we evaluated core temperatures and intraoperative thermal management in patients undergoing spinal or epidural anesthesia. Hypothermia was common, however, rarely detected either by temperature monitoring or estimates by anesthesiologists. In addition, it was not treated with active warming. Consequently, temperature monitoring and management have to be done during neuraxial anesthesia.     

The etiology and management of inadvertent perioperative hypothermia

Mild perioperative hypothermia is a frequent complication of anesthesia and surgery. Core temperature should be monitored during general anesthesia and during regional anesthesia for large operations. Reliable sites of core temperature monitoring include the tympanic membrane, nasopharynx, esophagus, bladder, rectum, and pulmonary artery. The skin surface is not an acceptable site for monitoring core temperature. Anesthetic-induced vasodilation initially rapidly decreases core temperature secondary to an internal redistribution of heat rather than an increased heat loss to the environment. Both general and regional anesthetics impair thermoregulation, increasing the interthreshold range; that is, the range of core temperatures over which no autonomic respose to cold or warmth occurs. Preinduction skin surface warming is the only means to prevent this initial redistribution hypothermia. Forced-air warming is the most effective method of rewarming hypothermic patients intraoperatively.     

The importance of monitoring intramyocardial temperature during hypothermic myocardial protection.

In 50 patients undergoing cardiac operation, hypothermic cardioplegic solution was infused into the root of the aorta immediately after aortic cross-clamping. Cardiac standstill was achieved within 1 to 3 minutes. However, monitoring of intramyocardial temperature with a needle thermistor revealed that such core cooling is unpredictable (the intramyocardial temperature achieved ranged from 7 degrees to 33 degrees C), unstable (this temperature can rise at more than 0.5 degrees C per minute), and uneven (a difference of up to 17 degrees C was observed between the intramyocardial temperature of the anterior and posterior left ventricular sites). The area supplied by the stenotic coronary artery was least protected. Monitoring of intramyocardial temperature enables one to know when supplementary cooling is indicated. We conclude that widespread differences in this temperature during cardiac operation make monitoring advisable for optimal myocardial protection.     

Perioperative thermoregulation and temperature monitoring

Traditionally, hypothermia has been thought of and used perioperatively as a presumptive strategy to reduce cerebral and myocardial tissue sensitivity to ischemia. Evidence, however, is mounting that maintenance of perioperative normothermia is associated with improved outcomes in patients undergoing all types of surgery, even cardiac surgery. Ambient environmental temperature is sensed by free nerve endings in the dermal and epidermal layers of the skin, which are the axonal extensions of thermosensitive neurons found in the dorsal root ganglia. Free nerve endings in the skin, by means of transient receptor ion channels that are specifically thermosensitive, also may directly sense environmental temperature. This information is transmitted to the preoptic/anterior hypothalamic region of the brainstem, which coordinates efferent responses to abnormal temperature deviation. People have evolved a highly integrated thermoregulatory system that maintains core body temperature in a relatively narrow temperature range. This system, though, is impaired by the stress of regional and general anesthesia, and the added exposure that occurs during the surgical procedure. When combined, these factors can lead to unwanted thermal disturbances. In a cold operating room environment, hypothermia is the usual perioperative consequence; however, hyperthermia is more dangerous and demands immediate diagnosis. Intraoperative hypothermia usually develops in three phases. The first is a rapid decrease in core temperature following anesthetic induction, which mostly results from redistribution of heat from the core thermal compartment to the outer shell of the body. This is followed by a slower, linear reduction in the core temperature that may last several hours. Finally, a core temperature plateau is reached, after which core temperature remains virtually unchanged for the remainder of the procedure. The plateau can be passive or result from re-emergence of thermoregulatory control in patients becoming sufficiently hypothermic. Mild hypothermia in the perioperative period has been associated with adverse outcomes, including impaired drug metabolism, prolonged recovery from anesthesia, cardiac morbidity, coagulopathy, wound infections, and postoperative shivering. Perioperative temperature monitoring devices vary by transducer type and site monitored. More important than the specific device is the site of temperature monitoring. Sites that are accessible during surgery and give an accurate reflection of core temperature include esophageal, nasopharynx, bladder, and rectal sites. Core temperature also may be estimated reasonably using axillary temperature probes except under extreme thermal conditions. Rather than taking a passive approach to thermal management, anesthesiologists need to be proactive in monitoring patients in cold operating rooms and use available technology to prevent gross disturbances in the core temperature. Various methods are available to achieve this. Prewarming patients reduces redistribution hypothermia and is an effective strategy for maintaining intraoperative normothermia. Additionally, forced-air warming and circulating water garments also have been shown to be effective. Heating intravenous fluids does not warm patients, but does prevent fluid-induced hypothermia in patients given large volumes of fluid. This article examined the evolutionary adaptations people possess to combat inadvertent hypothermia and hyperthermia. Because thermal disturbances are associated with severe consequences, the standard of care is to monitor temperature during general anesthesia and to maintain normothermia unless otherwise specifically indicated.     

Characteristic changes between core and peripheral surface temperature related with postanesthetic shivering following surgical operations

The relationship between changes in the core and the surface temperature and postanesthetic shivering was studied in 100 patients who underwent general anesthesia. Patients were classified into four groups by the patterns of change in the core and peripheral surface temperature. Type II and type IV groups of patients showed a decrease in surface temperature during the major operation such as gastrectomy and radical mastectomy. Type I and type III groups of patients showed no lowered peripheral surface temperature and with low temperature difference between core and surface temperature during the operation. The patients in type II and IV groups showed increased difference between core and surface temperature. The postanesthetic shivering occured at significantly higher rate compared to the other two groups. As possible reasons of the shivering, operation of long duration and insufficient circulating blood volume were considered. Shivering reduces the temperature difference in the thermoregulatory homeostasis. However, in patients in type I and III, the rate of shivering was low. Evaluation of the difference between core and peripheral surface temperature may be important to manage body temperature at a steady level during the operation. The monitoring of body temperature difference between core and peripheral surface during the operation may be useful for predicting to occurrence of postanesthetic shivering.(Nishimura C, Kanemaru K, Otagiri T: Characteristic changes between core and peripheral surface temperature related with postanesthetic shivering following surgical operations. J Anesth 4: 350–357, 1990)     

Malignant hyperthermia

Malignant hyperthermia of anesthesia is a severe complication and must be treated vigorously. The anesthetic should be stopped and the core body temperature reduced. Systemic complications must be anticipated, hopefully prevented, and appropriately treated. Appropriate laboratory studies must be obtained. A comprehensive family survey may alert the physician to a tendency toward this problem. Temperature monitoring during surgery may give an early warning of malignant hyperthermia developing. I would suggest that routine temperature monitoring during surgery be considered by the anesthesia department during each general anesthetic administration.     

The accuracy and precision of body temperature monitoring methods during regional and general anesthesia

We tested the hypotheses that accuracy and precision of available temperature monitoring methods are different between spinal anesthesia (SA) and general anesthesia (GA), and that patients receiving SA are at equal risk for hypothermia as those receiving GA. Patients scheduled for radical retropubic prostatectomy were enrolled. Either GA (n = 16) or SA (n = 16) was given according to patient and clinician preference. Temperatures were monitored with thermocouple probes at the tympanic membrane, axilla, rectum, and forehead skin surface. Tympanic temperatures were also measured with an infrared device, and forehead skin temperatures were monitored with two brands of liquid crystal thermometer strips. Accuracy and precision of these monitoring methods were determined by using tympanic membrane temperature, measured by thermocouple, as the reference core temperature (T(c)). At the end of surgery, T(c) was similar between SA (35.0 +/- 0.1 degrees C) and GA (35.2 +/- 0.1 degrees C) (P = 0.44). Accuracy and precision of each temperature monitoring method were similar between SA and GA. Rectal temperature monitoring offered the greatest combination of accuracy and precision. All other methods underestimated T(c). These findings suggest that patients receiving SA or GA are at equal and significant risk for hypothermia, and should have their temperatures carefully monitored, recognizing that most monitoring methods underestimate T(c). IMPLICATIONS: Body temperature should be monitored during spinal anesthesia because patients are at significant risk for hypothermia. Rectal temperature is a valid method of measuring core temperature, whereas other methods tend to underestimate true core temperature.     

Changes in temperature during transurethral resection of the prostate under peridural anesthesia

Superficial and central body temperatures were measured during anaesthesia and recovery in eleven elderly patients undergoing transurethral resection under epidural anaesthesia. A significant decrease in central body temperature as measured on the tympanic membrane was found during surgery. After a significant increase during induction of anaesthesia, mean skin temperature remained stable throughout surgery. Mean body temperature calculated from central body temperature and mean skin temperature decreased significantly during surgery. During recovery, all temperatures increased significantly. But mean body temperature returned to normal faster than central body temperature. Routine monitoring of core temperature and the use of warmed irrigation fluids are recommended during transurethral resections in elderly patients.     

TEMPERATURE MONITORING DURING GENERAL ANAESTHESIA

A study of core temperature monitoring during general anaesthesiaindicates that this can be introduced as a routine procedurein order to reduce mortality from malignant hyperpyrexia. Thetemperature profiles of 2410 patients are presented. Both meanrectal and mean oesophageal temperatures decreased during generalanaesthesia. The mean oesophageal temperatures were on average0.6°C less than the mean rectal temperatures during thefirst hour of anaesthesia. An increase in core temperature occurredin nearly 20% of patients. This appeared to be related to aninitially low body temperature. Core temperatures during generalanaesthesia were significantly greater in patients who receivedthe combination of suxamethonium and halothane than in patientsreceiving other drugs. This observation is of theoretical interestand suggests that the increase of temperature in malignant hyperpyrexiamay be an exaggeration of a normal response to these agents. ^* Present address: Department of Anaesthesia, National CardiovascularCentre, Osaka, Japan.     

The influence of active warming on signal quality of pulse oximetry in prehospital trauma care

Victims of trauma such as contusions and simple fractures are usually transported by paramedics. Because many victims are intoxicated with alcohol or other drugs, they are vulnerable to some risk of inadequate respiration. Thus, their oxygenation is monitored by noninvasive pulse oximetry. We tested the hypothesis that active warming of the whole body during transport to the hospital can improve the reliability of arterial oxygen saturation (SpO(2)) monitoring. Twenty-four trauma patients transported to hospital were included in the study and randomly assigned to two groups: one group (n = 12) was covered with normal wool blankets, and the other group (n = 12) was treated with resistive heating blankets during transport. We recorded core temperature, shivering, skin temperature at the forearm and finger, SpO(2), and hemodynamic variables. Before randomization, both groups were comparable. On arrival at the hospital, the actively warmed patients had significantly warmer core (36.1 +/- 0.3 degrees C versus 35.5 +/- 0.3 degrees C; P < 0.001) and skin (34.1 +/- 1.5 degrees C versus 24.9 +/- 1.4 degrees C; P < 0.001) temperatures. In the actively warmed group, the pulse oximeter had significantly fewer alerts (31 versus 58) and a significantly less time of malfunction (146 +/- 42 s versus 420 +/- 256 s) and provided more constant measurements in the actively warmed group (P < 0.001). In this study we showed that active warming improves pulse oximeter monitoring quality in trauma patients during transport to the hospital. IMPLICATIONS: Clinical trials show that pulse oximeter signal quality is limited by hypothermia. In this study we show that active whole-body warming of trauma victims improves monitoring quality during transport to the hospital.