老年结直肠手术患者围手术期体温对压疮发生风险的影响分析

目的探讨老年结直肠手术患者围手术期体温异常对发生压疮风险的影响,为提高围手术期护理质量提供参考。方法选择2011年1月至2013年7月我院择期结直肠手术老年患者325例,对患者围手术期体温进行监测,按体温差异分为术中低体温组,术中正常体温组,术后低体温组,术后高体温组,术后正常体温组,比较各组术前、术后3dBarden评分,出院前记录压疮发生例数。分析各组Barden评分差异及压疮发生率差异。结果术中低体温组术后3dBarden低于正常体温组,压疮发生率高于正常体温组。术后低体温组术及术后高体温组术后3dBarden评分低于正常体温组,压疮发生率高于正常体温组。结论术中及术后低体温增加压疮发生风险,围手术期应采取合适护理措施,预防低体温发生。     

预防围术期低体温的研究进展

体温是是生命体征之一,体温的维持在围手术期间起着重要作用。低体温是指低于36℃,临床上一般将中心体温34℃-36℃称为轻度低体温。围术期低体温是手术过程中极易造成的一种现象,在患者手术过程中中,50%-70%患者术中会发生低体温。手术中患者出现低体温,还会引起很多其他的并发症,原来所有的医务人员都未引起重视,近年来随着     

肝移植新肝期体温维护的研究

目的:探讨维护新肝期体温的有效措施.方法:将73例使用充气式保温毯、血液加温仪、40℃温水间断冲洗、有完整体温记录的肝移植患者作为对照组;将肝移植手术中增加使用变温水毯的47例患者做为实验组.观察2组患者进入手术室、无肝期、新肝期的体温变化及最低体温出现时间并进行比较.结果:实验组与对照组除进入手术室、切皮期体温差异无统计学意义外(P>0.05),其余术中不同时间体温差异均有统计学意义(P<0.001).对照组最低体温(34.77±0.93)℃,距门静脉开放后时间为(22.20±33.25)min;实验组最低体温(35.96±0.74)℃,距门静脉开放前时间为(33.40±92.84)min.结论:在新肝期提前升高变温水毯温度比仅使用充气式保温毯、血液加温仪、40℃温水间断冲洗等更有效,术中能有效防止低体温的出现.     

成人肝移植新肝期低体温对预后的影响

目的观察成人肝移植围术期体温变化趋势及术中新肝期低体温对患者预后的影响。方法回顾性分析我院2015年1月至2016年12月行肝移植术的成人患者107例,男62例,女45例,年龄25~65岁,ASAⅢ或Ⅳ级。记录麻醉诱导后(T_0)、切皮即刻(T_1)、无肝期即刻(T_2)、门静脉开放即刻(T_3)、开放后5min(T_4)、关腹即刻(T_5)、出室(T_6)时的体温,观察其总体体温变化趋势。以再灌注期核心体温35℃且持续时间5 min者为低体温组,再灌注期核心体温≥35℃或体温35℃但持续时间5min者为正常体温组,比较两组患者术中出血量、尿量、术后拔管时间、ICU停留时间和住院时间,分析新肝期(T_4~T_6)体温对患者手术及预后的影响,并进行低体温持续时间与预后的相关性分析。结果肝移植围术期体温总体呈现先下降(T_0~T_4)后上升(T_4~T_6)的变化趋势,T_4时体温降至最低,为(34.8±0.6)℃,低于正常体温(35.0℃),此时处于身体的低体温状态。与T_0时比较,T_2~T_5时体温明显降低(P0.05)。与正常体温组比较,低体温组出血量明显增多,术后拔管时间明显延长(P0.05)。两组患者尿量、ICU停留时间及住院时间差异无统计学意义。术中低体温持续时间与出血量、拔管时间、ICU停留时间呈正相关,与尿量呈负相关,与住院时间无明显相关性。结论肝移植再灌注期低体温会增加患者出血量,延长术后拔管时间;低体温持续时间越长,越不利于患者预后。     

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]、     

胸腔镜肺叶手术患者苏醒室低体温现况及影响因素

目的 探讨胸腔镜肺叶手术患者苏醒室低体温现况及影响因素,为开展针对性体温干预提供参考。方法 回顾性调查胸腔镜肺叶手术患者222例,将发生苏醒室低体温的患者作为病例组,以1∶1比例匹配苏醒室未发生低体温的患者(对照组),比较两组围手术期特征。结果 胸腔镜肺叶手术患者中93例(41.89%)发生苏醒室低体温;匹配成功两组各92例,经单因素与多因素分析,年龄、BMI、麻醉类型、麻醉时长、入室核心体温、手术准备时间是患者苏醒室低体温发生的主要影响因素(P<0.05,P<0.01);苏醒室低体温患者苏醒室停留时间、住院时间显著延长,并伴有尿量减少(均P<0.01)。结论 胸腔镜肺叶手术患者苏醒室低体温发生率偏高,护理人员应评估围手术期患者年龄、麻醉类型、麻醉时长、准备时间、BMI、入手术室核心体温,积极预防苏醒室低体温的发生,同时关注苏醒室低体温给患者造成的风险。     

大面积烧伤患者切削痂植皮术后低体温护理干预效果

50%～70%的外科手术患者可发生轻度低体温[1],围手术期体温低于36 ℃称为体温过低[2],较为常见.它激发交感神经兴奋、代谢亢进、储备耗竭,引发代谢及水、电解质、酸碱平衡紊乱,脏器功能不全,免疫功能降低,凝血障碍以及复温过程中的种种并发症,常加重病情,给患者造成严重损害甚至死亡.因此,患者围手术期低体温不容忽视,应积极采取相关护理措施维持体温恒定.为此我们在大面积烧伤切削痂植皮围手术期,采用一系列措施对患者低体温进行干预,并对相关临床指标进行观察.     

术前预加温维持患者核心体温有效性的Meta分析

目的:系统评价术前预加温维持术中核心体温的有效性,为围手术期体温管理提供临床依据。方法:计算机检索PubMed、Web of Science、the Cochrane Library、EMBACE、CINAHL、中国知网、万方数据库、维普、中国生物医学文献数据库,全面搜集术前预加温对手术患者术中核心体温影响的随机对照试验(randomized controlled trial,RCT),检索时限为2000年1月至2019年4月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献,评价纳入文献质量,并进行数据提取,采用RevMan 5.3软件进行Meta分析。结果:纳入14个RCT,共902例患者。Meta分析结果显示:术前预加温组在麻醉诱导后30、60、90 min时以及手术结束时患者的核心体温明显高于对照组,而在术中和术后低体温的发生率方面则低于对照组,差异有统计学意义(P<0.05)。但两组在术后寒战的发生率方面差异无统计学意义(P>0.05)。结论:术前实施预加温能有效提升患者术中的核心体温,降低低体温的发生率。     

丙泊酚与七氟醚对患儿围术期体温的影响

目的比较丙泊酚与七氟醚对骨科围术期小儿体温的影响。方法择期行全麻下先天性髋关节脱位切开复位内固定术的患儿68例,男4例,女64例,随机均分为两组:丙泊酚组(P组)和七氟醚组(S组)。P组麻醉诱导及维持使用丙泊酚,S组麻醉诱导及维持使用七氟醚,观察并记录麻醉诱导前5min(T0)、麻醉诱导后5min(T1)、15min(T2)、30min(T3)、45min(T4)、60min(T5)、75min(T6)、90min(T7)、105min(T8)、120min(T9)体温;观察手术时间、麻醉时间、术中输液量和围术期低体温及寒颤发生情况。结果与T0时比较,T1~T8时两组体温明显降低,T7、T8时P组体温明显高于S组(P0.05);S组患儿术中低体温发生率为8例(23.5%),明显高于P组的1例(2.9%)(P0.05)。两组手术时间、麻醉时间、术中输液量差异无统计学意义,术后患儿均无寒颤发生。结论行先天性髋关节脱位切开复位内固定术的患儿,术中体温呈先下降后上升趋势。与丙泊酚比较,在麻醉诱导后90min内,七氟醚更易导致小儿围术期低体温的发生。     

肩关节镜术中低体温情况的观察性研究

目的观察肩关节镜术中围手术期低体温的发生率以及影响因素。 方法回顾性分析2020年6月至2020年9月以及2020年12月至2021年2月于本院治疗的161例肩关节镜手术患者,排除1例年龄过小、2例合并颈椎病、3例数据不全的患者,实际入组参与研究患者155例,其中左侧肩66例、右侧肩89例;男50例、女105例（男：女=1:2）;平均年龄（58.87±11.50）岁（19~79岁）。126例肩袖损伤,9例肩关节不稳定,1例肱骨大结节骨折,16例冻结肩,3例钙化性肌腱炎。记录患者的基本资料、手术时长、麻醉分级、麻醉方式、术中体温保护措施、手术室的温度,对这些数据进行统计学的分析,评估围手术期低体温的发生率以及危险因素。 结果针对155例肩关节镜患者的资料分析结果可见手术开始时有43例患者的体温均处于低体温状态,112例患者处于正常范畴,低体温发生率为27.74%。而在手术结束时出现低体温状态的患者有62例,而93例患者处于正常范畴,术后的低体温发生率为40%。所有的低体温状态均处于轻度的围手术期低体温范畴。麻醉后出现低体温的患者中,性别和BMI的比值差异具有统计学意义,而术中及结束时出现低温的情况则与年龄、性别、手术时间、灌注量和保温措施相关。并且当手术时间超过90 min后,灌注液对核心体温的影响起到了主导作用。 结论肩关节镜手术中多种因素与围手术期低体温相关,常温灌注液体也对核心体温起到一定的影响作用,导致围手术期低体温的发生。     

Warming by resistive heating maintains perioperative normothermia as well as forced air heating

Background. Even mild perioperative hypothermia is associatedwith several severe adverse effects. Resistive heating has possibleadvantages compared with other active warming systems becauseit can heat several fields independently. To assess this newwarming system, we measured core temperature in patients duringsurgery who were warmed with circulating water mattresses, forcedair covers or resistive heating covers. Methods. Twenty-four patients undergoing laparoscopic cholecystectomywere randomly assigned to (i) circulating water mattress (38°C),(ii) forced air warming (set to ‘medium’) or (iii)carbon-fibre resistive warming (38°C). Warming was appliedthroughout anaesthesia and surgery. The groups were comparedusing one-way ANOVA and Student–Newman–Keuls tests. Results. Confounding factors were similar among the groups.Core temperatures in each group decreased for 20 min, but subsequentlyincreased in the forced air and resistive heating groups. Therewas no significant difference between the forced air and resistiveheating groups at any time. In contrast, core temperature inthe circulating water group continued to decrease. Consequently,core temperature in the circulating water group was significantlylower than in the other groups 30 min after anaestheticinduction and at later times. Conclusions. Resistive heating maintains core body temperatureas well as forced air heating and both are better than circulatingwater. Resistive heating offers the advantage of adjustableheating pods. Br J Anaesth 2003; 90: 689–91     

人体不同部位红外温度计体温测量值的比较研究

目的探讨人体不同部位用不同体温计测量体温值的差异,为临床体温测量部位和工具提供参考。方法采用自身同期对照设计,以手持非接触式红外温度计测量前额、颞部、颈部正中、颈部外侧、眼内侧角、耳垂后、耳道7个体表位置温度,分别间隔距离1.5cm、5.0cm进行测量,同时以水银体温计测量腋下温度作为参照。结果共纳入患者76例。非接触式红外温度计测得7个部位的体温总体比较,差异有统计学意义(间隔1.5cm组与间隔5.0cm组,均P0.01),耳道温度最高,前额温度最低。非发热患者前额、颞部体温与腋温比较,差异有统计学意义(P0.05,P0.01);发热患者前额、颞部、颈部体温与腋温比较,差异有统计学意义(P0.05,P0.01),相差最大的前额温度与腋温差值可达0.62℃;耳道温度最接近腋窝温度,差异无统计学意义(P0.05)。结论耳道温度更接近腋温,推荐在发热筛查时以耳道作为测量部位。非接触式红外体温计与体表皮肤间隔5.0cm测量体温可以在保证准确性的同时减少接触风险,但测量耳道时可适当缩短测量距离以使测量更加准确。     

Baseline Body Temperatures of Patients With Myelopathy

ABSTRACT

In myelopathy patients, baseline body temperatures and effects of common ambient temperatures have not been measured. Oral (OT), rectal (ReT) and room (RmT) temperatures were measured between 5 and 7 A.M. in 46 myelopathy patients (one female) aged 61 ± 14 (mean± 1 standard deviation) who had been paralyzed 20 ± 12 years. Their levels of paralysis were cervical in 34, dorsal in 11, lumbar in one. OT was 36.2 (97.1°F) ± 0.6°C and RT 36.7 (98.0®F) ± 0.6®C, correlation coefficient (r) = 0.723. RmT was 23.9 ± 1.9®C (75.1 ± 3.4®F), but RmT did not correlate with ReT, r = 0.088, in spite of a 19°F difference between the extremes of RmT. In conclusion, the early morning body temperature of myelopathy subjects is lower than the generally recognized norm but is unaffected by a moderately wide range of ambient temperatures in a hospital setting. (J Am Paraplegia Soc; 17: 146–147)     

红外线测温仪测量人迎穴温度的可行性探讨

目的探讨红外线体温测量仪测量人迎穴温度代替测量额温的可行性,寻找一种准确快速且安全可靠的体温测量方法。方法随机抽取在院患者148例,同时分别用水银体温计测量患者的腋温,用红外线测温仪测量患者额温和人迎穴温度。结果腋温、额温及人迎穴温分别为(36.71±0.06)℃、(36.21±0.06)℃、(36.18±0.06)℃,三种方法测得的温度比较,差异有统计学意义(P<0.01)。人迎穴温、额温分别与腋温存在统计学差异(均P<0.05),人迎穴温与额温比较,差异无统计学意义(P>0.05)。结论红外线测温仪只宜用于体温初步检测;使用红外线测温仪测量体温时,可选择人迎穴代替前额测温,既简便快捷又避免伤害眼部晶体。     

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)     

Qualitative assessment of thermal and evaporative adjustments of human scrotal skin in response to heat stress

To study scrotal thermoregulation and its efficacy to work against heat accumulation, five subjects were exposed to four experimental conditions under which core and skin temperatures and sweat evaporative responses of various skin surfaces—chest, abdomen and scrotum—were compared. The temperature response of the scrotal area exhibited the largest inertia, and this observation is likely to be the consequence of heat exchange via the vascularization of testes and scrotum which is more efficient than in other parts of the body in limiting local heat storage, thus alleviating heat stress of the testis. The pulsatile nature and the synchronous pattern of the scrotal evaporative heat loss indicate that scrotal sweating takes place, although the gradient response appeared to be less marked than elsewhere in the body. Relatively low and inert scrotal temperature can partly explain this poor local drive for sweating.     

In vitro validation of the Affinity NT oxygenator arterial outlet temperatures

During cardiopulmonary bypass, the rates of cooling and rewarming and the maximum temperatures attained are implicated in patient morbidity. Thus, accurate oxygenator arterial outlet temperature measurements are needed. The purpose of this study was to determine the accuracy of the arterial outlet temperature probe on the "Affinity NT" membrane oxygenator in measuring perfusate temperatures. An in vitro circuit was used. Crystalloid solution was recirculated through an Affinity NT membrane oxygenator and, to simulate the patient, a second oxygenator. Water was recirculated through the heat exchanger of the second oxygenator via a reservoir. A myocardial temperature probe was inserted in-line 4 cm distal to the Affinity NT oxygenator arterial outlet temperature probe and was considered to measure the actual temperature of the perfusate. Temperatures were simultaneously recorded from the in-line probe, arterial outlet probe, and reservoir every second. Twenty-seven trials were run using random combinations of three Affinity NT oxygenators and three in-line probes. Each trial entailed cooling an initially normothermic reservoir to 28 degrees C and then rewarming it to normothermia again. The arterial outlet temperature probe on the Affinity NT membrane oxygenator underestimated the perfusate temperatures during early rewarming (bias of 0.72 degrees C; precision of +/-1.15 degrees C) and late rewarming (bias of 0.52 degrees C; precision of +/-0.97 degrees C). An overestimation of the perfusate temperatures occurred during early cooling (bias of -0.57 degrees C; precision of +/-1.37 degrees C). Only during the late cooling phase was the arterial outlet temperature probe accurate (bias of -0.02 degrees C; precision of +/-0.3 degrees C). The perfusionist should be aware of the temperature probe monitoring characteristics of the oxygenator to safely perfuse the patient.     

无线体温监测和位置跟踪传感器在ICU重症患者体温监测中的应用

目的探讨无线体温监测和位置跟踪传感器(下称传感器)在ICU重症监护患者体温测量中的有效性。方法随机抽取180例入住ICU的重症监护患者,采用同期自身对照方法分别使用传感器和水银体温计测量体温,比较测温结果有无差异,并比较两种测温方法每日所需护理耗时。结果各时间点及不同年龄患者传感器与水银体温计所测温度比较,差异无统计学意义(均P>0.05)。每日测温所需护理时间两种方法比较,差异有统计学意义(P<0.01)。结论传感器测温准确、安全,提高了护理质量,节省了护理工作时间,提高了工作效率。     

Effects of small peripheral temperature changes on the evoked baseline electromyographic response

BACKGROUND: Since muscle temperature seems to influence the electrically evoked compound muscle action potentials, we wanted to quantificate the effect of light external cooling and warming on evoked responses in a clinical setting. METHODS: In ophthalmic surgical patients (ASA I-III), evoked electromyographic (EMG) responses to supramaximal train-of-four stimuli were measured once a minute. After obtaining an initial baseline (100%) where temperatures of the first dorsal interosseal muscle and the skin above it had stabilised, the patients' hands were cooled to stable temperatures by a blower (room air). A new baseline was established and, subsequently, the hand re-warmed to the starting temperature. The cooling procedure was repeated, operation time allowing. RESULTS: The mean (range) muscle and skin temperature changes were from 36.0 degrees C (35.5-37.1) to 34.6 degrees C (33.2-36.1) and 35.7 degrees C (35.0-36.7) to 32.0 degrees C (29.4-35.6), respectively. The mean (range) change of the EMG-response was 8.0%/degree C (0.3-16.5) for the muscle and 4.1%/degree C (0.3-37.9) for the skin. Wide individual variability was evident. CONCLUSION: The electrically evoked EMG-response is sensitive to even small changes in temperature at the measurement site. Therefore, when applying the evoked EMG in neuromuscular studies, peripheral skin or muscle temperatures need to be monitored, and attempts to stabilise the temperature of the monitored muscles should be made.