全麻下妇科开腹围手术期低温及易感因素初探

目的　探索全麻下妇科开腹手术中患者的体温变化及低温易感因素 ,给麻醉医师提供临床实践的理论基础。方法　 5 0例择期开腹行子宫切除术或宫颈癌根治术患者 (ASA分级Ⅰ Ⅲ级 ) ,随机分为保温 (W )组和非保温(NW)组。持续监测鼻咽温度。统计低温发生率及年龄、体表面积、手术时间、出血量和输注液体总量与温度的关系。结果　年龄、体表面积与围术期温度相关。NW组患者低温发生率为 36 % (9/ 2 5 ) ,其中浅低温发生率为 2 8% (7/ 2 5 ) ,中低温发生率为 8% (2 / 2 5 )。两组失血量、静脉输液量、手术时间与体温变化无明显关联。结论　全麻开腹行妇科手术应全程进行体温监测 ,并且应用充气温控制毯维持正常体温。对于老年患者和体表面积较小患者尤应注意温度的变化及术后并发症的预防。

Hypothermia and Prediction during Gynecological Surgery with General Anesthesia

Objective To discuss the predictors and incidence of hypothermia in patients undergoing gynecological surgery.Methods Patients were either not warmed or actively warmed with forced-air warming. Clinical variables were assessed as predictors of core body temperature including age, body surface, duration of procedure, estimated blood loss, amount of intravenous fluids administered and the use of forced-air warming. Results The study demonstrated that advanced age is a risk factor for hypothermia and decreased body surface is associated with lower final body temperatures in the group of patients that were not warmed. Severe intraoperative hypothermia occurred in 2 of 25 patients(8%) who were not warmed. The complications associated with hypothermia included delayed time to extubation.Conclusions Patients undergoing gyneclogical surgery are at risk for the development of intraoperative hypothermia and require careful temperaturte monitoring. Elderly patients and patients with low body surface are more prone to develop low intraoperative core body temperatures. To avoid hypothermiarelated complications, active warming with forced-air warmers should be considered for patients at risk for intraoperative hypothermia and for patients who develop hypothermia intraoperatively.