围术期低体温病人保温护理研究进展

综述了手术病人低体温的原因以及低体温对机体的影响,并对各类保温护理措施加以比较,提出复合保温是防治病人围术期低体温发生的重要方法.     

综合保温技术在预防术中低体温中的应用

综述病人在围术期发生低体温的原因、低体温对机体各系统的影响以及综合保温技术在临床上的应用,以减少手术并发症,提高病人满意度,推进优质护理服务,促进病人康复。     

复合保温措施预防胃癌根治术病人术中低体温的效果观察

[目的]探讨复合保温措施预防胃癌根治术病人术中低体温的效果。[方法]横断面整群选取施行胃癌根治术病人106例,按照配对原则随机分为常规保温组和复合保温组各53例,比较两组病人进入手术室时、麻醉后每隔30min直至手术结束病人离开手术间的全部直肠温度及麻醉复苏时间。[结果]两组病人在入手术室后直肠温度比较差异无统计学意义(P0.05),随着麻醉的进行,复合保温组病人直肠温度高于常规保温组(P0.01),且复合保温组病人低体温发生率(3.77%)低于常规保温组(92.45%);复合保温组病人术后麻醉复苏时间为27.76min±12.08min,低于常规保温组病人(37.73min±16.18min)(P0.01)。[结论]在胃癌根治术过程中对病人实施复合保温护理措施能维持病人体温在正常范围内,预防低体温的发生,同时有利于缩短病人的麻醉苏醒时间。     

改良充气保温被在麻醉恢复室低体温病人复温中的应用效果观察

[目的]探讨改良充气保温被在麻醉恢复室(PACU)低体温病人复温中的应用效果,为临床寻找安全、有效、经济、方便的复温措施提供理论依据。[方法]选取某三级甲等医院PACU低体温病人80例,按照随机数字表法将病人分为改良充气保温被组和充气加温毯组,每组40例。在PACU分别采用改良的充气保温被和充气加温毯对病人进行复温,比较两组病人的复温时间、复温速度、PACU停留时间、寒战发生情况。[结果]两组病人复温时间、复温速度、PACU停留时间及寒战发生情况比较差异均无统计学意义(P0.05)。[结论]轻度低体温病人应用改良的充气保温被可以达到充气加温毯的复温效果,同时降低了成本,适用于PACU低体温病人复温。     

腹腔暴露与围手术期低体温的关系及护理

本文通过对开腹手术与非开腹手术病人的围手术期体温情况的观察,研究体腔开放该因素对围手术期低体温的影响程度,以提高我们对围手术期低体温的认识,从而在手术中对开腹手术病人采取相应的保温措施以防止低体温的发生。     

手术病人术中低体温监测方法和保暖措施的研究进展

介绍术中病人体温监测最新方法和最新保温措施,以激发临床工作者的创新思维,为更好地预防手术病人术中低体温提供依据,从而降低术中病人低体温发生率,促进病人康复.     

综合保温措施预防肝移植术中低体温的护理

肝移植术中低体温发生率高,对术后恢复影响较大,常可危及生命,造成术中低体温的因素较多,通过对低体温发生的原因分析,采取了行之有效的综合性保温措施,使病人术中维持正常体温,有效地降低了低体温引起的并发症。     

综合保温措施预防肝移植术中低体温的护理

肝移植术中低体温发生率高,对术后恢复影响较大,常可危及生命,造成术中低体温的因素较多,通过对低体温发生的原因分析,采取了行之有效的综合性保温措施,使病人术中维持正常体温,有效地降低了低体温引起的并发症.     

红外监测输液控制器在预防手术病人术中低体温中的探讨

[目的]评价红外监测输液控制器配合充气式加温毯对预防手术病人术中低体温的影响。[方法]入选胃肠外科、肝胆外科全身麻醉下行开腹手术病人150例,随机分为对照组和观察组,各75例。对照组给予常规盖被保温、手术间温度调节,充气加温毯保温,试验组在给予对照组同样综合保温措施的基础上,应用输液控制器进行液体、血制品加温。比较2组病人术前30min、手术开始后1h、2h、3h、离开手术室前以及回到病房2h后6个时间段体温变化及低体温的发生率。[结果]试验组各时间段体温无明显变化,低体温的发生率明显低于对照组,差异有统计学意义(P0.05)。[结论]使用红外监测输液控制器对病人进行综合保温,建立体温管理指导,加强术中核心体温的监测,根据病人术中体温的变化进行保温措施的调节,避免了手术期间低体温的发生,保持病人体温稳定,降低了术后并发症的发生率。     

高龄病人静吸麻醉术后低体温的原因分析和护理

高龄外科手术病人麻醉术后低体温常常是术后死亡的重要原因.为探讨其发生原因及其防治方法,对402例消化外科静吸麻醉术后的高龄病人的体温进行了观察.结果发现,术后体温低于36.0℃者346例,占86.1%,原因主要包括麻醉术后肌肉松弛产热少,对应激反应能力差,术中不注意保温和心理因素等.经术后护理和保温措施后,93.1%的低体温病人4小时内体温恢复,未发生因低体温而死亡者.结果表明,高龄外科手术病人麻醉术后低体温发生率较高,积极采取多种形式的护理措施,可避免并发症,降低死亡率,取得满意效果.     

心脏直视手术围术期低体温和体温监测进展

对心脏直视手术围术期低体温和体温监测进展进行综述，主要内容包括围术期低体温的形成、影响因素、核心体温监测及综合性体温保护技术。     

Etiology and sequelae of perioperative accidental hypothermia

Accidental hypothermia is a frequent event during the perioperative period. Recent studies revealed a drop in core temperature of over 2 degrees C in more than 50% of all patients undergoing an operation. This drop in core temperature seems to be primarily due to the following factors. Anaesthesia prevents behavioural adaptations to changes in ambient temperature. Simultaneously, autonomic mechanisms of temperature control are suppressed by general as well as by neuraxial anaesthesia. The interthreshold range between core temperatures that trigger responses to warmth and to cold increases up to 20-fold. This is primarily due to a decrease in the cold response threshold. As a result, body core temperature of anaesthetized patients is primarily determined by the much lower temperature of the environment. On one hand, decreases in body temperatures may exert organ protective effects under certain conditions, e.g., by increasing ischemic tolerance. On the other hand, there is accumulating evidence that accidental perioperative hypothermia may also adversely affect organ function and outcome. For example, unfavourable effects of perioperative hypothermia on the immune defence, on the function of the coagulation system, on cardiovascular performance, as well as on postoperative recovery have been reported. Consequently, measures should be taken to actively control the perioperative heat balance of patients.     

Thermoregulation: anesthetic and perioperative concerns

Hypothermia has long been common in anesthesia and has largely been seen as an inconvenience. For many years, it was viewed as inevitable. But hypothermia is much more than an inconvenience, and it is no longer inevitable. Hypothermia is closely associated with significant morbidity both intraoperatively and postoperatively. Hypothermia may begin in the preoperative holding area, so efforts to prevent it should begin there as well. Effective intraoperative and postoperative warming methods are known and commonly available, but they remain underused. Understanding how and why core temperature declines in association with anesthesia and surgery and safe, effective methods to prevent that decline will enable nurse anesthetists and perioperative nurses to increase both the comfort and safety of their patients while reducing costs to the institution.     

AANA journal course. Update for nurse anesthetists. A common sense approach to hypothermia

Hypothermia frequently is considered inadvertent in the perioperative setting. The preservation of vital body heat has been an issue since the 1800s. This article provides a select review of the causes of hypothermia and the methods for prevention of hypothermia during the perioperative period. Providing patients with an environment designed to foster normothermia can preclude the costs of longer hospital stays, prevent morbid conditions associated with hypothermia, and provide patients with a more comfortable perioperative experience. Our goal as perioperative healthcare providers is a normothermic perioperative experience for all patients.     

Postoperative hypothermia--the chilling consequences

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UNPLANNED HYPOTHERMIA is commonly encountered in the perioperative period. Nursing has contributed to the literature on hypothermia with studies on shivering and treatment modalities; however, the direct physiological consequences of postoperative hypothermia have been reported mainly in the medical literature.

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RESEARCH ON THE PHYSIOLOGICAL effects of postoperative hypothermia offers nurses further evidence to support interventions for temperature correction in patients with hypothermia. Evidence indicates that forced-air warming is the most effective method for warming hypothermic patients.

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THE ROY ADAPTATION MODEL is explained as a framework for nursing care of patients with hypothermia. Clinical practice guidelines for unplanned perioperative hypothermia also are provided. AORN J 83 (May 2006) 1055-1066.

     

Detrimental effects of hypothermia: a systems analysis.

Hypothermia influences body functions in many positive and negative ways. Hypothermia may be purposely induced during neurological or cardiac surgery for its cerebral protectant effects. However, hypothermia during the perioperative period is often detrimental, leading to increased bleeding and blood product utilization, as well as prolonged stays in the PACU. This article presents an overview of the physiology of temperature regulation and risk factors for the development of perioperative hypothermia. The effects of hypothermia on various body systems also are discussed and perioperative concerns explored.     

腹部手术期间保温措施对老年患者凝血功能的影响

目的 探讨腹部手术期间保温措施对老年腹部手术患者凝血功能的影响. 方法 将2007年9月-2008年8月在普外科施行腹部手术的60例老年患者随机分为观察组和对照组各30例.对照组接受常规的治疗和护理,观察组在对照组的基础上加以一系列体温保护措施.比较2组患者术前术后体温、血小板计数(PLT)、凝血活酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)定量的变化及术中出血量.进行t检验及χ2检验. 结果 观察组患者围手术期体温无显著变化,低体温发生率显著低于对照组;各项凝血功能指标亦显著优于对照组. 结论 老年患者腹部手术期间发生的轻度低体温会影响患者的凝血功能,增加手术出血量,积极的保温措施可有效维持患者体温恒定.     

腹部手术期间保温措施对老年患者凝血功能的影响

目的探讨腹部手术期间保温措施对老年腹部手术患者凝血功能的影响。方法将2007年9月-2008年8月在普外科施行腹部手术的60例老年患者随机分为观察组和对照组各30例。对照组接受常规的治疗和护理,观察组在对照组的基础上加以一系列体温保护措施。比较2组患者术前术后体温、血小板计数（PLT）、凝血活酶原时间（PT）、活化部分凝血活酶时间（APIT）、凝血酶时间（TT）、纤维蛋白原（Fbg）定量的变化及术中出血量。进行t检验及X^2检验。结果观察组患者围手术期体温无显著变化,低体温发生率显著低于对照组;各项凝血功能指标亦显著优于对照组。结论老年患者腹部手术期间发生的轻度低体温会影响患者的凝血功能,增加手术出血量,积极的保温措施可有效维持患者体温恒定。     

The effects of intravenous fluids temperature on perioperative hemodynamic situation, post-operative shivering, and recovery in orthopaedic surgery

BACKGROUND: Perioperative hypothermia is physiologically stressful because it elevates blood pressure, heart rate and plasma catecholamine concentration that may increase the risk of cardiac complications, bleeding, wound infection, and post-anaesthesia care unit stay. This study was designed to evaluate the effects of warming intravenous fluids on perioperative hemodynamic situation, post-operative shivering and recovery in orthopaedic surgery patients. METHODS: Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in sixty patients undergoing orthopaedic surgery that were randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using a dry IV fluid warmer. RESULTS: The core and skin temperatures of the hypothermia and normothermia groups decreased significantly between the induction of anesthesia and the end of surgery, but the drop was greater in the hypothermia group (P < 0.005). Postoperative mean arterial blood pressure (non-invasive) increased significantly more in the hypothermia group versus normothermia group (p < 0.005). Shivering was observed in 21 of 30 in the hypothermia group and 11 of 30 in the normothermia group (p < 0.005) and recovery time was significantly lower in the normothermia group (36 +/- 5 vs. 26 +/- 3 min, p < 0.005). CONCLUSION: Intraoperative IV fluid warming reduces perioperative changes to the hemodynamic situation, post-operative shivering, and recovery time.     

社区卫生机构中护理人员对护士角色功能认知现状的调查研究

目的：调查社区卫生机构中护士对护士角色功能认知的现状,以便找出社区护士对其角色功能认知的局限与不足,为社区护理管理者更好地提高护士认知度和护理水平提供依据.方法：以本市6所社区卫生服务中心的126名护士为研究对象,自制调查问卷,调查护士对自身角色功能的认知及现阶段护士主要的工作内容.结果：调查发现社区护士绝大部分（83.33％）能够认识到自身承担的照顾者角色,对其他角色的认知度偏低,依次为教育者、代言者、管理者、合作者及研究者,且对角色功能的了解程度偏低.结论：社区卫生机构中护士对护士角色功能的认知严重缺乏全面性,对自身角色功能的发挥程度较低,需要加大投入对护士进行培训,提高护士对自身角色功能的认知度,以充分发挥护士在社区医疗中的角色功能,提高护理质量.