温热液体对人工关节置换患者术中低体温及术后免疫应激反应的影响

目的探讨术中应用温热液体对人工关节置换患者术中低体温发生率及术后免疫应激反应的影响。方法选取择期行人工关节置换术的患者,随机分为温热组和常温组。温热组44例,术中输入36.5～37.5℃的温热液体(包括库存血),并采用37℃的恒温冲洗液冲洗术区;常温组44例,术中输入22～24℃液体及库存血,并用等温冲洗液冲洗术区。观察患者术中1 h、2 h、3 h和术毕即刻低体温发生率;术前、术毕即刻、术后12 h、24 h、48 h、72 h的白介素-6、白介素-10、C-反应蛋白、瘦素的变化。结果①温热组术中2 h、3 h及术毕即刻,低体温发生率低于常温组(P0.01)。②温热组白介素-6数值在术毕及术后48 h低于常温组,其他各指标比较差异均无统计学意义。结论温热液体有利于降低人工关节置换术中低体温发生率,且可能对减缓免疫应激反应的程度有一定的作用。     

静脉输注温热液体对双侧人工关节置换术患者血糖的影响

目的探讨静脉输注温热液体对双侧人工关节置换术患者血糖的影响。方法选取行双侧关节置换术患者,随机分为温热组和常温组。温热组患者44例,术中静脉输入温度为36.5～37.5℃的温热液体及库存血,并采用37℃恒温冲洗液进行术区冲洗;常温组患者44例,术中静脉输入备于手术室（室温为22～24℃）的常温液体及库存血,并用常温冲洗液进行术区冲洗。观察两组患者血糖浓度在术中各观察时间点的变化。结果随着手术进程,两组患者血糖增长趋势略有不同;温热组患者血糖浓度略低于常温组,但差异无统计学意义（P〉0.05）;温热组患者高血糖发生率在术中2h、3h及术毕即刻均低于常温组,差异有统计学意义（P〈0.05）。结论术中应用温热液体静脉输注可缓解双侧人工关节置换术患者应激性血糖的升高,且可能对减缓机体应激反应有一定的作用。     

温热液体在人工关节置换术中的应用

目的：观察应用温热液体时,行人工关节置换术中患者体温、失血量以及麻醉苏醒时间等指标的变化,为这项技术应用于临床提供依据。方法选行人工关节置换术患者50例（全膝置换或全髋置换）,随机分为温热组和常温对照组,每组各25例。温热组患者术中输入温度为36.5℃-37.5℃的温热液体,并用37℃的恒温冲洗液对手术区进行冲洗;常温对照组患者术中静脉输入常温（23-25℃）液体,并用相同温度冲洗液进行手术区冲洗。观察术中两组患者体温、失血量,麻醉苏醒时间的变化。结果温热组患者体温波动平稳、下降幅度小,低体温发生率低,失血量明显减少,麻醉苏醒时间明显缩短（P〈0.05）。结论人工关节置换术中应用温热液体有利于患者术中体温恒定,减少低体温发生率,减少术中出血量,缩短麻醉苏醒时间,值得在临床上推广使用。     

温热液体对下肢多发性骨折患者术中低体温及术后感染的影响

目的 探讨术中应用温热液体对多发性骨折患者术中低体温及术后感染的影响.方法 选择80例择期手术的多发性骨折患者,随机分为温热组和常温组.温热组40例,术中输入36.5～37.5℃的温热液体(包括库血),并采用37℃的恒温冲洗液冲洗术区；常温组40例,术中输入22～24℃液体及库血,并用等温冲洗液冲洗术区.观察患者术中1h、2h、3h和术毕即刻低体温发生率,术后伤口感染率.结果 温热组术中2h、3h及术毕即刻,低体温发生率低于常温组,2组比较差异有统计学意义(P＜0.01)；温热组发生术后感染1例,常温组发生术后感染3例,温热组感染发生率低于常温组,2组比较差异有统计学意义(P＜0.01).结论 温热液体有利于降低多发性骨折患者低体温发生率及术后感染率.     

双侧人工关节置换术病人术中应用温热液体对术后寒战及心肌耗氧量的影响

[目的]明确术中应用温热液体对择期行双侧人工关节置换术病人术后寒战及心肌耗氧量的影响,为临床术中病人应用温热液体提供依据。[方法]选取择期行双侧人工关节置换术（双侧髋关节置换术或双侧膝关节置换术）病人88例,随机分为温热组和常温组。温热组术中静脉输入温度为36.5℃～37.5℃的温热液体（包括库存血）,并采用温度为37.0℃的恒温冲洗液进行术区冲洗;常温组术中静脉输入常温（22℃～24℃）液体及库存血,并用同温度的常温冲洗液进行术区冲洗。观察术后寒战及寒冷不适情况、心肌耗氧量的变化。[结果]常温组病人术后寒战及寒冷不适感发生率明显高于温热组（P〈0.05或P〈0.01）,寒战程度及寒冷不适度较温热组严重（P〈0.01）;常温组病人心肌耗氧量自术后10min起均明显高于温热组（P〈0.05）,且术后2h内心肌耗氧量均明显高于麻醉诱导后值（基础值）,而温热组仅在术后10min时高于基础值。[结论]双侧人工关节置换术病人术中给予温热液体有利于降低术后寒战发生率,减轻寒战严重程度及寒冷不适度,降低心肌耗氧量,缩短心肌耗氧量升高持续时间。     

术中应用温热液体对人工关节置换术患者血压、心率影响的研究

目的探讨术中应用温热液体对双侧人工关节置换术患者血压、心率的影响,为临床此类患者术中应用温热液体提供依据。方法选取择期行双侧人工关节置换术(双侧髋关节置换术或双侧膝关节置换术)患者,随机分为温热组和常温组。温热组患者44例,术中静脉输入温度为36.5～37.5℃的温热液体(包括库存血),并采用温度为37℃的恒温冲洗液进行术区冲洗;常温组患者44例,术中静脉输入22～24℃液体及库存血,并用同温度的常温冲洗液进行术区冲洗。观察患者围术期心率、血压的变化。结果(1)温热组患者术中心率、血压均低于常温组,但差异无显著意义;(2)温热组术后心率、舒张压、平均动脉压自术后10min起均低于常温组,差异有显著意义(P0.05),其收缩压自术后30min起亦低于常温组,差异有显著意义(P0.05)。结论双侧人工关节置换术患者术中应用温热液体,在减缓体温下降的同时,亦不增加其术中心率及血压,且有利于维持术后心率、血压的稳定,对手术患者有利。     

双侧人工关节置换术病人术中应用温热液体对术后寒战及心肌耗氧量的影响

[目的]明确术中应用温热液体对择期行双侧人工关节置换术病人术后寒战及心肌耗氧量的影响,为临床术中病人应用温热液体提供依据.[方法]选取择期行双侧人工关节置换术(双侧髋关节置换术或双侧膝关节置换术)病人88例,随机分为温热组和常温组.温热组术中静脉输入温度为36.5 ℃～37.5 ℃的温热液体(包括库存血),并采用温度为37.0 ℃的恒温冲洗液进行术区冲洗;常温组术中静脉输入常温(22 ℃～24 ℃)液体及库存血,并用同温度的常温冲洗液进行术区冲洗.观察术后寒战及寒冷不适情况、心肌耗氧量的变化.[结果]常温组病人术后寒战及寒冷不适感发生率明显高于温热组(P＜0.05或P<0.01),寒战程度及寒冷不适度较温热组严重(P<0.01);常温组病人心肌耗氧量自术后10 min起均明显高于温热组(P<0.05),且术后2 h内心肌耗氧量均明显高于麻醉诱导后值(基础值),而温热组仅在术后10 min时高于基础值.[结论] 双侧人工关节置换术病人术中给予温热液体有利于降低术后寒战发生率,减轻寒战严重程度及寒冷不适度,降低心肌耗氧量,缩短心肌耗氧量升高持续时间.     

综合保温措施对老年腹部手术患者凝血功能的影响

目的了解术中低体温对老年腹部手术患者凝血功能的影响,探讨综合保温措施保持患者术中体温与改善凝血功能的作用。方法将60例〉65岁行腹部手术的老年患者随机分为保温组和非保温组各30例。保温组采用保温毯、温热盐水湿润冲洗腹腔、加温输液等保温措施,非保温组给予常规护理。记录两组手术前、手术1h时、术毕的肛温变化和术中失血量、输血量,并检测患者术前、术毕凝血功能指标。结果与保温组比较,非保温组手术1h时和术毕体温较低,术中出血量、失血量均较多;术毕凝血酶时间延长,血小板计数、纤维蛋白原均低于保温组,差异均有统计学意义（P〈0.05）。结论老年腹部手术患者术中易发生低体温;低体温可影响凝血功能、增加术中出血量;采取综合保温措施可保持老年腹部手术患者的体温,改善凝血功能。     

老年患者术中体温变化的研究

目的探索维持老年患者术中体温稳定的措施，减少围术期低体温的发生。方法胸腹部手术老年患者40例，随机分为观察组与对照组，各组20例。对照组未采取加温措施，观察组使用加温垫、充气暖被、加温输液和输血、37℃冲洗液等措施，观察记录术前、皮肤消毒后、术中、术毕体温及失血量和术后气管导管拔管时间。结果与对照组比较，观察组低体温的发生率、失血量、术后气管拔管时间明显低于对照组（P〈0．05）。结论老年手术患者术中采取综合性保温措施，可维持正常体温，术中及术后并发症发生率降低。     

护理干预对全麻手术期间老年患者体温的影响

目的探讨维持老年患者术中体温稳定的措施,减少围手术期低体温的发生。方法胸腹部手术老年患者60例,随机分为观察组与对照组,每组30例。观察组全程使用红外线辐射加温、加温垫、充气式暖被、加温输液、37℃冲洗液等综合措施;对照组采用常规保温措施。观察记录两组手术前、皮肤消毒后、术中、术毕体温及失血量、术后气管导管拔管时间和术后寒战发生率。结果观察组低体温发生率30％,失血量（452±83）ml,术后气管插管拔管时间（42±11）min,术后寒战发生率23．3％;均低于对照组（P〈0．05或P〈0．01）。结论护理干预即综合性保温措施可保持老年患者术中体温稳定,术中及术后并发症发生率降低。     

术中静脉输入温液体对腹部手术患者体温的影响

目的评估术中静脉输入温液体对手术期维持正常人体核心温度的有效性。方法将134名ASA（美国麻醉医师学会）Ⅰ级或Ⅱ级且在腹部外科手术中采用普通的麻醉方式的成年患者随机分成对照组和试验组。对照组（n=67）静脉输入的液体维持于室温状态,试验组（n=67）静脉输入的液体温度在37℃,手术开始后每隔30min测量1次体温。结果对照组前3h人体核心温度降至（35.50±0.13）℃,稳定至麻醉结束;试验组前60min人体核心温度降低,在麻醉结束时升至（36.91±0.17）℃。对照组26名患者出现2级及以上寒战,试验组没有患者出现2级及以上寒战（P〈0.01）。结论静脉输入温液体在维持患者正常体温及防止术后寒战均有效果,为预防围手术期低体温提供一种简便且有效的方法。     

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.     

Can latent heat safely warm blood? – in vitro testing of a portable prototype blood warmer

Background

Trauma/retrieval patients are often in shock and hypothermic. Treatment of such patients usually involves restoring their blood volume with transfusion of blood (stored at 2°C – 6°C) and/or crystalloids or colloids (stored at ambient temperature). Rapid infusion of these cold fluids can worsen or even induce hypothermia in these patients. Warming of intravenous fluids at accident sites has traditionally been difficult due to a lack of suitable portable fluid warmers that are not dependent on mains electrical or battery power. If latent heat, the heat released when a liquid solidifies (an inherently temperature limiting process) can warm intravenous fluids, portable devices without a reliance on electrical energy could be used to reduce the incidence of hypothermia in trauma patients.

Methods

Rapid infusion of red cells into patients was timed to sample typical clinical flow rates. An approved dry heat blood warmer was compared with a prototype blood warmer using a supercooled liquid latent heat storage material, to warm red cells whilst monitoring inlet and outlet temperatures. To determine the effect of warming on red cell integrity compared to the normal storage lesion of blood, extracellular concentrations of potassium, lactate dehydrogenase and haemoglobin were measured in blood which had been warmed after storage at 2°C – 6°C for 1 to 42 days.

Results

A prototype latent heat fluid warmer consistently warmed red cells from approximately 4°C to approximately 35°C at typical clinical flow rates. Warming of stored blood with latent heat did not affect red cell integrity more than the approved dry heat blood warmer.

Conclusion

Using latent heat as an energy source can satisfactorily warm cold blood or other intravenous fluids to near body temperature, without any adverse affects.     

术中保温对老年开胸患者生命体征的影响

目的 观察术中保温对老年开胸患者生命体征的影响.方法 将60例行开胸手术老年患者随机分为保温组和对照组,每组30例.保温组患者术中控制室温22～24℃,输入的液体加温至37 ℃,并选用加温至37℃的灌洗液进行胸腔冲洗;对照组患者术中仅控制室温,不采用任何保温措施.测定术前及术后核心体温,比较两组患者围手术期的收缩压、心率、体温变化和寒战发生情况.结果 保温组患者术中体温维持稳定,手术前后体温、收缩压、心率、无明显变化,在人室时、消毒时和手术中1 h及手术结束前差异无统计学意义(P>0.05);对照组患者与术前及保温组比较,术中体温显著下降,收缩压、心率波动明显(P<0.01);而保温组低温(<36℃和<35℃)、寒战发生率显著低于对照组(P<0.01).结论 老年开胸患者术中保温可维持患者体温的稳定,有效预防术中低温和寒战的发生.     

Preventing hypothermia during continuous veno-venous haemodiafiltration: a randomized controlled trial

BACKGROUND: Continuous veno-venous haemodiafiltration is a common form of dialysis used in intensive care units. Unfortunately, patients often experience hypothermia as a side-effect of the therapy because of the necessity for extracorporeal blood flow. Intensive care nurses aim to prevent hypothermia developing. Intravenous fluid warmers are sometimes added to the dialysis circuit in an attempt to maintain patient temperature. However, the efficacy of this method has not been previously studied. AIM: This paper reports a study to investigate whether intravenous fluid warmers prevent hypothermia during continuous veno-venous haemodiafiltration. METHOD: A prospective randomized controlled trial was carried out in the intensive care unit of a metropolitan, tertiary-referral, teaching hospital. After Ethics Committee approval, 60 circuits in continuous veno-venous haemodiafiltration mode (200 mL/minute blood flow, 1 L/hour countercurrent dialysate, 3 L/hour pump-controlled ultrafiltration and prefilter fluid replacement of 1.7-2.0 L/hour) were studied. Circuits were randomized to have either an intravenous fluid warmer set at 38.5 degrees C on the dialysate and 1 L/hour of replacement fluid lines or no fluid warmer. Patient core temperature was recorded at baseline and then hourly. Hypothermia was defined as a core temperature <36.0 degrees C. RESULTS: Mean core temperature loss did not vary between circuits with or without a fluid warmer (0.92 degrees C vs. 1.11 degrees C, P = 0.339). Survival analysis found no difference in hypothermia incidence between groups (log rank = 0.47, d.f. = 1, P = 0.491). Lower baseline temperature (RR 0.142, 95% CI 0.044, 0.459, P = 0.001) and female gender (RR 0.185, 95% CI 0.060, 0.573, P = 0.003) were significant risks for hypothermia. CONCLUSIONS: Intravenous fluid warmers used as described do not prevent hypothermia during continuous veno-venous haemodiafiltration. Female patients and those with a low-normal baseline temperature are most likely to become hypothermic during this form of dialysis. Further research is needed to address effective ways of preventing hypothermia in critically ill patients receiving continuous renal replacement therapies.     

冬季前列腺电切术后3种膀胱冲洗方法的效果比较

目的探讨经尿道前列腺电切术后不同膀胱冲洗方法对患者术后并发症的影响以及冲洗费用的区别，指导临床选择经济实惠、安全有效的膀胱冲洗方法。方法将45例患者随机分为3组各15例，常规组采用传统室温下的冲洗液持续膀胱冲洗；简易加温组采用2只wk-1型自调温加热器并排放置，将入路输液管末端嵌入加热槽，设置温度35℃后持续膀胱冲洗；系统加温组采用Warmflo液体加温系统，将专用的加温袋平铺于加热轨道中，控制温度在35℃，持续膀胱冲洗。比较3种持续膀胱冲洗方法对患者术后出血，膀胱痉挛、手术前后体温差、冲洗时间、冲洗费用的差异。结果简易加温组、系统加温组术后出血、膀胱痉挛、低体温发生率均低于常规组，冲洗时间短于常规组（P〈0．05）；简易加温组、常规组冲洗费用比较差异无统计学意义（P〉0．05），简易加温组冲洗费用低于系统加温组（P＜0．01）。结论采用wk-1型自凋温加热器加温膀胱冲洗液的方法可以减少患者术后出血、膀胱痉挛、低体温发生，缩短膀胱冲洗时间，而且并不增加患者经济负担，是一种安全有效、经济实惠的膀胱冲洗方法。