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。     

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.     

The Safe and Efficient Use of Forced-Air Warming Systems

Maintaining perioperative normothermia is important to ensure that a patient does not experience inadvertent hypothermia and its consequences, such as increased blood loss, cardiac abnormalities, prolonged recovery, and increased risk for wound infection. Many clinical guidelines recommend the use of forced-air warming as one of several techniques to prevent inadvertent perioperative hypothermia. Safe use of forced-air warming devices includes choosing the right device, assessing the patient for risks, protecting the patient from burn injuries, appropriately maintaining the patient’s body temperature, and using the device as directed by the manufacturer’s recommendations. Staff members should receive education on hypothermia and warming technology on a regular basis.     

Hypothermia in surgical patients.

During the perioperative period little attention is given to thermoregulation. This can lead to hypothermia which has severe physiological complications. This article discusses the causes and effects of hypothermia in surgical patients and describes a study that the author conducted to discover the level of awareness on the subject among operating department staff.     

胃肠道手术围手术期体温保护对手术部位感染的影响

目的探讨胃肠道手术围手术期体温保护对手术部位感染（SSI）的影响。方法回顾性分析1536例于我院普外科接受胃肠道手术病例，将2006年7月以前收治的病例764例纳入对照组，将2006年7月以后收治的病例772例纳入观察组。观察组在常规围手术期护理基础上加以一系列体温保护措施，对照组仅接受常规围手术期护理。比较2组患者手术部位感染的发生情况。结果观察组患者SSI发生率显著低于对照组（P〈0．01）。结论胃肠道手术患者围手术期发生低体温可显著增加术后SSI发生率，采取适当保温措施可预防轻度低体温发生，防止手术部位感染。     

胃肠道手术围手术期体温保护对手术部位感染的影响

目的 探讨胃肠道手术围手术期体温保护对手术部位感染(SSI)的影响.方法 回顾性分析1536例于我院普外科接受胃肠道手术病例,将2006年7月以前收治的病例764例纳入对照组,将2006年7月以后收治的病例772例纳入观察组.观察组在常规围手术期护理基础上加以一系列体温保护措施,对照组仅接受常规围手术期护理.比较2组患者手术部位感染的发生情况. 结果 观察组患者SSI发生率显著低于对照组(P<0.01). 结论 胃肠道手术患者围手术期发生低体温可显著增加术后SSI发生率,采取适当保温措施可预防轻度低体温发生,防止手术部位感染.     

Temperature measurement in the phase I PACU.

Perioperative hypothermia remains a common occurrence in the Phase I PACU. Identification of and appropriate intervention for this complication is of prime importance in the prevention of adverse outcomes. This article provides an overview of perioperative hypothermia and offers a summary of the most common methods used to measure body temperature.     

Intraoperatively acquired pressure ulcers and perioperative normothermia: a look at relationships

The risk of developing an intraoperatively acquired pressure ulcer (IAPU), which is recognized as a significant complication of deep tissue injury occurrence, is associated with duration of surgery and patient positioning. There is a strong association between hypothermia, tissue viability, and surgical site infections; however, the relationship between hypothermia and pressure ulcers has not been fully explored. We examined the incidence of pressure ulcers in surgical patients and determined that there is a relationship between maintaining perioperative normothermia and a reduction in IAPU development. We used a retrospective, explanatory, nonexperimental design, and we fit a binary logistic model to the data. This study shows that patients at higher risk for developing an IAPU include those who are critically ill, have a low Braden Scale skin assessment score, are thin, and are male with at least a 1° F (1.8° C) drop in temperature. These are important risks for perioperative nurses to take into account during care of surgical patients. More perioperative research is needed to identify ways to reduce risk, provide close assessment of high-risk patients, and implement the identified risk-reduction strategies.     

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.

     

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.     

Novel applications of therapeutic hypothermia: report of three cases

Therapeutic hypothermia can provide neuroprotection in various situations where global or focal neurological injury has occurred. Hypothermia has been shown to be effective in a large number of animal experiments. In clinical trials, hypothermia has been used in patients with postanoxic injury following cardiopulmonary resuscitation, in traumatic brain injury with high intracranial pressure, in the perioperative setting during various surgical procedures and for various other indications. There is thus evidence that hypothermia can be effective in various situations of neurological injury, although a number of questions remain unanswered. We describe three patients with unusual causes of neurological injury, whose clinical situation was in fundamental aspects analogous to conditions where hypothermia has been shown to be effective.     

腰椎管狭窄症患者行单边双通道内镜手术的围术期护理

总结腰椎管狭窄症患者经单边双通道内镜手术的围手术期护理经验。 2019年3月-2021年7月笔者所在医院收治55例腰椎管狭窄症行单边双通道内镜手术的患者,术前做好心理护理、精细化术前准备,术中做好体位护理及手术配合,术后预防低体温、低血压,做好神经功能的观察和护理,观察头痛、脑脊液漏的发生情况,积极预防并发症。 55例患者均顺利完成手术,无术中转为开放手术的病例,平均手术时间为(68.29±18.42)min,神经减压充分,术后腰椎神经受压症状明显缓解,术后恢复良好。     

Temperature balance and the possibility of its maintenance during general anesthesia in children

The problems of hypothermia in the perioperative period, which are one of the most important ones in pediatric practice, in babies in particular, are solved, by using a broad spectrum of methods for preventing and correcting the patients' thermal balance. Convection heating systems exercise an on-line control over the baby's thermal regime during a surgical intervention and intensive care. The authors' own experience allows these systems to be recommended for wide practical application in the activities of anesthesiology and intensive care services.     

Adoption of the ASPAN clinical guideline for the prevention of unplanned perioperative hypothermia: a data collection tool.

Perioperative hypothermia remains a common occurrence despite the development and dissemination of a clinical practice guideline for the prevention of unplanned perioperative hypothermia by ASPAN. Unfortunately, a process for measuring compliance with and adoption of this guideline has yet to be developed. The purpose of this article is to describe a medical record abstraction method for determining the degree of adoption of the ASPAN Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia in the perianesthesia setting. Use of the instrument for future research is also explored.     

Reducing the risk of unplanned perioperative hypothermia

Maintaining normothermia is important for patient safety, positive surgical outcomes, and increased patient satisfaction. Causes of unplanned hypothermia in the OR include cold room temperatures, the effects of anesthesia, cold IV and irrigation fluids, skin and wound exposure, and patient risk factors. Nurses at Riddle Memorial Hospital in Media, Pennsylvania, performed a quality improvement project to evaluate the effectiveness of using warm blankets, warm irrigation fluids, or forced-air warming on perioperative patients to maintain their core temperature during the perioperative experience. Results of the project showed that 75% of patients who received forced-air warming perioperatively had temperatures that reached or were maintained at 36° C (96.8° F) or higher within 15 minutes after leaving the OR.     

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.     

The effect of arthroscopic irrigation fluid warming on body temperature.

The use of room temperature solutions for body cavity irrigation during surgical procedures can lead to the development of perioperative hypothermia. Hypothermia during this period causes patient discomfort, increases oxygen consumption, interferes with the clotting cascade, and increases the length of hospital stay. Perioperative hypothermia in anesthetized patients also contributes to extended sedation, delayed emergence, and prolonged recovery from neuromuscular blockade. Twenty-four adult American Society of Anesthesiologists (ASA) class I and II patients were randomly assigned to receive warmed arthroscopic irrigation solution or room-temperature irrigation solution in this randomized, prospective study. Tympanic temperatures were monitored every 15 minutes throughout the surgical and postanesthesia recovery periods. P < .05 was considered significant. Statistical comparison of the mean percent temperature decrease from preoperative baseline between the 2 groups did not support the hypothesis that patients receiving warmed irrigation solution would maintain a higher core body temperature than those receiving room temperature solution.     

Continuity created by nurses in the perioperative dialogue--a literature review

This literature review analyses eight research reports dealing with perioperative dialogues conducted between patients and nurses. The aim of this study was to summarise studies concerned with the perioperative dialogue as an organisation model for bringing safe operative practices and caring into perioperative nursing, by creating continuity for both patients and nurses in perioperative praxis and its research. How do patients and perioperative nurses experience the perioperative dialogue as a model? Perioperative nursing should be perceived as a caring profession emphasising that the focus is on perioperative caring. The perioperative dialogue has a humanistic and caring perspective and presents an ideal model on which to base perioperative nursing. There is general acceptance of the value of the perioperative dialogue for both patients and nurses as means of alleviating suffering and creating a safety nursing, with continuity in the process provided by nursing staff. This study suggests further research and that a means of measuring caring in the perioperative dialogue should be more developed.     

Prevention of unplanned perioperative hypothermia

HYPOTHERMIA is one of the most common complications experienced by surgical patients. Better postoperative patient outcomes are achieved when normothermia is maintained.PERIOPERATIVE NURSES should understand how to maintain normothermia, the causes of hypothermia, and adverse patient outcomes that result from hypothermia. Nursing interventions to help prevent hypothermia can be implemented during each phase of perioperative care. AORN J 88 (September 2008) 358-364. © AORN, Inc, 2008.