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1.
术前预保温对胃癌根治术患者术中体温变化的影响   总被引:6,自引:4,他引:2  
目的探讨术前预保温模式对胃癌根治术患者围手术期核心体温的影响。方法选取全麻下行择期胃癌根治术患者90例,随机分为术前预保温组、术中保温组和常规保温组,每组30例。术前预保温组患者在术前30min至手术结束给予强制充气加温毯加温;术中保温组患者进入手术室至麻醉开始给予单层棉被,麻醉开始至手术结束使用强制充气加温毯保温;常规保温组患者从术前入室至手术结束给予常规单层棉被保温处理。记录患者入室时、麻醉时、手术开始时、手术开始后每30分钟以及手术结束时的鼓膜温度。结果三组不同时间点鼓膜温度比较,干预主效应、时间主效应、交互效应均P<0.01;三组低体温及寒战发生率比较,差异有统计学意义(均P<0.01)。结论术前预保温模式有助于保持胃癌根治术患者术中体温相对稳定,有效避免围手术期低体温和术后寒战的发生率。  相似文献   

2.
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。  相似文献   

3.
目前,肩关节镜手术已成为治疗多种肩关节疾病的常规方法.与肩关节切开手术相比,肩关节镜手术有诸多优点:创伤小、术后疼痛减轻、术后感染发生率下降、住院时间短等.但是肩关节镜手术仍有可能发生某些术中并发症,严重者甚至危及患者生命安全[1,2].本文旨在提醒麻醉医师警惕肩关节镜手术中可能危及患者生命安全的并发症,确保肩关节镜手术的围术期安全.  相似文献   

4.
目的 探讨灌注流速对肩关节镜术的手术时间,患者肢体肿胀、疼痛和肩关节功能康复的影响.方法 将2020年6月至2020年9月在我院行肩关节镜下肩袖损伤修补手术患者92例.根据灌注流速不同,将患者随机分为0.6 L/min、0.8 L/min和1.0 L/min 3组,记录患者的基本资料、手术时间、灌注液总量及留存量,手术...  相似文献   

5.
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。  相似文献   

6.
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。  相似文献   

7.
目的探讨泌尿外科腔镜手术围术期保温护理对预防术中低体温的效果。方法选取2017-02-2019-07间接受泌尿外科腔镜手术治疗的78例患者。将2017-02-2018-05间入院的38例患者作为常规组,围术期应用常规护理措施。将2018-06-2019-07间入院的40例患者作为保温组,围术期在常规护理基础上实施保温护理措施。回顾性分析患者的临床资料。结果常规组术中30 min及术后10 min的体温明显低于术前,差异有统计学意义(P<0.05)。保温组患者术中30 min及术后10 min的体温变化差异无统计学意义(P>0.05)。常规组术中低温、寒战等并发症发生率高于保温组,差异有统计学意义(P<0.05)。结论对行泌尿外科腔镜手术的患者加强围术期保温护理,可保持患者术中体温的稳定,减少术中低体温及相关并发症的发生风险,有利于提高治疗效果。  相似文献   

8.
37℃灌注液预防全麻下经皮肾穿刺取石术中的低体温   总被引:2,自引:0,他引:2  
经皮肾穿刺取石术(Percutaneous nephrolithotomy,PCNL)主要用于治疗肾结石和复杂的输尿管上段结石.由于PCNL手术时间较长,术中需大量生理盐水灌注,因此患者术中及术后易发生低体温,并对患者麻醉恢复期产生不良影响.本研究观察37℃温生理盐水灌注液对患者体温及麻醉恢复期的影响,以寻求一种有效预防该类手术患者体温下降的方法,提高围术期的安全性.  相似文献   

9.
目的探讨对前列腺汽化电切手术患者围术期实施复合保暖护理措施对防治术中低体温的疗效。方法回顾分析159例前列腺汽化电切手术患者围术期预防术中低体温的护理措施。结果 159例手术中145例患者体温保持正常,9例出现术中低体温,5例出现术中寒颤,均经对症处理后症状缓解。未出现严重感染、心功能异常等其他并发症病例。结论对于前列腺汽化电切术患者围术期复合保暖护理措施可降低术中低体温及寒颤的发生率,减少并发症发生。  相似文献   

10.
目的 探索胆道外科手术患者核心体温围术期全流程智能监测方法,为围术期体温监护创新提供实证方案。方法 在胆道外科病房及麻醉手术中心建设基于穿戴式无线体温传感器的智能体温监测系统,对手术患者实施围术期全流程连续体温监测。结果 2019年10月至2021年7月共监测胆道外科手术患者3 383例,与仅监测术中体温相比,围术期监测到更多低体温事件(35.74%vs.44.37%)、更低的体温最低值(36.13℃vs.35.98℃)、更大的体温跌幅(0.29℃vs. 0.47℃)、更长的低体温时间(81.00 min vs.165.00 min),均P<0.05。结论 患者核心体温围术期全流程智能监测可实现围术期全程体温监测,真实、动态、连贯地反映患者围术期体温变化,有助于指导精准、个体化的围术期体温管理。  相似文献   

11.
目的构建肩关节镜手术患者术中低体温风险预测模型并检验其预测效果。 方法选取2019年1月至2020年7月北京大学人民医院261例肩关节镜手术患者为研究对象,其中2019年1月至12月为建模组(n=174),2020年1月至7月为验证组(n=87),采用单因素分析筛选变量,通过Logistic回归建立模型,并进行Hosmer-Lemeshow拟合优度检验,采用受试者操作特征曲线下面积评价模型的预测效果。 结果建模组患者术中低体温发生率为56.32%(98/174),验证组为42.53% (37/87);最终模型包括3个预测因子:基础体温(OR=0.033)、麻醉时间(OR=1.002)和BMI(OR=0.845)。Hosmer-Lemeshow检验P=0.377,AUC为0.858,Youden指数为0.603,灵敏度为0.735,特异度为0.868。模型验证显示正确率为83.84%。 结论本研究构建的模型具有较好的预测效果,可为临床评估肩关节镜手术患者术中低体温风险提供参考。  相似文献   

12.
Background and objectivesSeveral airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures.MethodsForty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation.ResultsA positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference.ConclusionsEndotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.  相似文献   

13.
The etiology and management of inadvertent perioperative hypothermia   总被引:10,自引:0,他引:10  
Mild perioperative hypothermia is a frequent complication of anesthesia and surgery. Core temperature should be monitored during general anesthesia and during regional anesthesia for large operations. Reliable sites of core temperature monitoring include the tympanic membrane, nasopharynx, esophagus, bladder, rectum, and pulmonary artery. The skin surface is not an acceptable site for monitoring core temperature. Anesthetic-induced vasodilation initially rapidly decreases core temperature secondary to an internal redistribution of heat rather than an increased heat loss to the environment. Both general and regional anesthetics impair thermoregulation, increasing the interthreshold range; that is, the range of core temperatures over which no autonomic respose to cold or warmth occurs. Preinduction skin surface warming is the only means to prevent this initial redistribution hypothermia. Forced-air warming is the most effective method of rewarming hypothermic patients intraoperatively.  相似文献   

14.
BackgroundCore-to-peripheral redistribution of heat, secondary to sympathetic-mediated vasodilation, is the major mechanism leading to early perioperative hypothermia after neuraxial anesthesia. The study aim was to determine if preoperative anterior thigh (peripheral lower extremity) temperature predicted perioperative temporal (core) temperature decrease during cesarean delivery with spinal anesthesia.MethodsSecondary analysis of data derived from a prospective, randomized study of 46 healthy women undergoing scheduled cesarean delivery with spinal anesthesia was performed. Anterior thigh temperature was measured preoperatively prior to spinal anesthesia. The primary outcome was maximum perioperative temporal temperature decrease. Secondary outcomes included incidence of temporal hypothermia (temperature <36°C), shivering, and thermal comfort scores. This study ran concurrently with a previously published trial comparing no active intraoperative warming with active warming.ResultsThere was no correlation between preoperative anterior thigh temperature and maximum perioperative temporal temperature decrease (r=−0.049, P=0.751). The mean ± standard deviation preoperative anterior thigh temperature of women who developed temporal hypothermia compared to those who did not was 32.4 ± 0.8°C versus 32.4 ± 0.70°C respectively (P=0.995). Preoperative anterior thigh temperature did not correlate with the incidence of shivering (r=0.267, P=0.080) or thermal comfort scores (r=0.233, P=0.129).ConclusionPreoperative anterior thigh temperature does not correlate with the degree of perioperative temporal temperature decrease, likelihood of developing hypothermia, shivering, or thermal comfort during cesarean delivery with spinal anesthesia. Although core-to-peripheral redistribution of heat after neuraxial anesthesia is a major mechanism of perioperative heat loss, a lower extremity temperature prediction hypothesis was not confirmed in this population.  相似文献   

15.
Pannen BH 《Der Anaesthesist》2007,56(9):940-944
For a long time the significance of perioperative accidental hypothermia was overlooked. The possible undesirable effects of a relatively small reduction in the body core temperature of 1.5-2.0 degrees C were generally unknown and the treatment options were limited. The unfavourable climatic conditions in the operation room favour heat loss and simultaneously, there is considerable disturbance of temperature regulation through general as well as spinal anaesthesia. In many studies it has now been shown that the resulting decrease in body temperature can have a negative effect on immune function, coagulation, the cardiovascular system and recovery behaviour. Heat loss in the perioperative phase should, therefore, be minimised by effective insulation. Nevertheless, a negative heat balance can often only be avoided by an additional heat treatment of the body surface which ideally should be initiated in the preoperative phase. If large volumes must be infused, an important additional measure is to prewarm these solutions. This is the only way in which the objective, to avoid a fall in body temperature to below 36 degrees C in the perioperative phase and the possible subsequent negative effects on the course of events, can be reached. The incidence of perioperative hypothermia is often underestimated so that in this phase a reduction in body core temperature of more than 2 degrees C will occur in more than 50% of patients if no special measures are undertaken. In addition, the undesirable effects of such a reduction in core temperature were barely known and even only a few years ago there were hardly any possibilities for reliable prevention or effective treatment. Therefore, in this article the causes of perioperative hypothermia will initially be described. In the second section the possible negative consequences of a reduction in body core temperature will be presented and in the last section the resulting consequences for the practice will be discussed.  相似文献   

16.
Inadvertent postoperative core hypothermia is associated with multiple physiological effects, especially in patients admitted to the intensive care unit (ICU). Despite previous reports of the relationship between patient, surgical, and anesthetic factors and immediate postoperative core hypothermia, this information might need to be reconsidered in the light of progress in surgery, anesthetic, and warming techniques. We designed this prospective study of 194 postgeneral surgical patients to assess the incidence, predictive factors, and outcome of core hypothermia (tympanic membrane core temperature [Tc] <36.0 degrees C) at the time of admission to the general ICU in a large tertiary university medical center from December 2000 to March 2001. The following variables were studied: age, sex, body weight, body surface area, preoperative body temperature, ASA physical status, history of diabetic neuropathy, emergency surgery, surgical subspecialty performing surgery, type of surgery, type of anesthesia (general, regional, or combined epidural and general), temperature monitoring, use of a forced air warming technique, amount of fluid and blood replacement, duration of anesthesia, duration of surgery, and the ambient operating room temperature. Other outcomes, i.e., length of ICU stay and mortality, were also assessed. The incidence of core hypothermia was 57.1%, 41.3%, and 28.3% according to the definition of Tc <36.0 degrees C, <35.5 degrees C, and <35.0 degrees C, respectively. Multiple logistic regression showed the following risk factors for core hypothermia: high ASA physical status (odds ratio, 2.87; 95% confidence interval [CI], 0.82-10.03 for ASA II; odds ratio, 8.35; 95% CI, 1.67-41.88 for ASA >II), magnitude of surgical procedure (odds ratio, 6.60; 95% CI, 1.66-26.19 for medium surgery; odds ratio, 22.23; 95% CI, 5.41-91.36 for major surgery), use of combined epidural and general anesthesia (odds ratio, 3.39; 95% CI, 1.05-10.88), and duration of surgery >2 h (odds ratio, 4.50; 95% CI, 1.48-13.68). Not using temperature monitoring seems to be a risk factor as well (odds ratio, 3.00; 95% CI, 0.87-10.12). Significant protective factors against core hypothermia were heavier body weight (odds ratio, 0.94; 95% CI, 0.89-0.98), higher preoperative body temperature (odds ratio, 0.31; 95% CI, 0.15-0.65), and warmer ambient operating room temperature (odds ratio, 0.67; 95% CI, 0.51-0.88). In conclusion, the incidence of core hypothermia (Tc <36.0 degrees C) at the time of admission to the general ICU is still frequent. To reduce the incidence, more efforts and concern should be taken to prevent core hypothermia, especially in the patient with high ASA physical status, undergoing more intensive and lengthy surgery, and using combined epidural and general anesthesia. IMPLICATIONS: In an effort to decrease the frequent incidence of core hypothermia at the time of admission to the general surgical intensive care unit, this prospective study showed that high ASA physical status, the use of a combined epidural and general anesthesia, surgery lasting longer than 2 h, and extensive surgery were the important risk factors, whereas heavier body weight, higher preoperative body temperature, and warmer ambient operating room temperature were important protective factors.  相似文献   

17.
目的 观察术中输液加温对开腹胃肠道手术患者组织氧合灌注和苏醒期的影响。方法 随机选择ASA分级Ⅰ或Ⅱ级拟开腹胃肠道肿瘤手术患者60例,采用随机数字表法其分为对照组、输液加温组(加温组),每组各30例。对照组患者术中采用常规保温措施;加温组患者在常规保温措施的基础上术中使用输液加温仪持续输液加温,温度设置为41℃。记录两组患者麻醉诱导前10 min(T0)、手术开始时(T1)、手术开始1 h(T2)、手术开始2 h(T3)、术毕(T4)时的鼻咽温、中心静脉血氧饱和度(ScvO2)和动脉血乳酸(ABL);比较两组患者麻醉苏醒期自主呼吸恢复时间、拔管时间、PACU停留时间,寒颤、躁动发生率,躁动评分(RS)、Ramsay镇静评分(RSS)及患者麻醉满意度。结果 加温组T2、T3、T4时的鼻咽温、ScvO2均较对照组高(P < 0.05),ABL较对照组低,但差异无统计学意义(P > 0.05);与对照组相比,加温组麻醉苏醒期自主呼吸恢复时间、拔管时间、PACU停留时间明显缩短,寒颤、躁动发生率显著降低,躁动评分(RS)更低、Ramsay镇静评分(RSS)及患者麻醉满意度更高(P < 0.05)。结论 术中输液加温可保证开腹胃肠道手术患者术中良好组织氧合灌注,有利于快速麻醉复苏,明显减少患者麻醉苏醒期寒颤及躁动发生,提高患者麻醉满意度。  相似文献   

18.
After the ingestion or infusion of nutrients, there is an increase in energy expenditure which has been referred to as dietary or nutrient-induced thermogenesis. This thermogenesis induced by protein or amino acids is well known to be largest and most prolonged. According to these physiological backgrounds, preoperative amino acid infusion was reported to prevent postoperative hypothermia during general anesthesia and spinal anesthesia. Also, perioperative amino acid infusion is reported to improve the outcome of the patients undergoing off-pump CABG. Amino acid infusion was observed to shift upward the threshold core temperature for thermoregulatory vasoconstriction as well as to increase energy expenditure. Fructose also prevents perioperative hypothermia during surgery by the same mechanisms.  相似文献   

19.
Traditionally, hypothermia has been thought of and used perioperatively as a presumptive strategy to reduce cerebral and myocardial tissue sensitivity to ischemia. Evidence, however, is mounting that maintenance of perioperative normothermia is associated with improved outcomes in patients undergoing all types of surgery, even cardiac surgery. Ambient environmental temperature is sensed by free nerve endings in the dermal and epidermal layers of the skin, which are the axonal extensions of thermosensitive neurons found in the dorsal root ganglia. Free nerve endings in the skin, by means of transient receptor ion channels that are specifically thermosensitive, also may directly sense environmental temperature. This information is transmitted to the preoptic/anterior hypothalamic region of the brainstem, which coordinates efferent responses to abnormal temperature deviation. People have evolved a highly integrated thermoregulatory system that maintains core body temperature in a relatively narrow temperature range. This system, though, is impaired by the stress of regional and general anesthesia, and the added exposure that occurs during the surgical procedure. When combined, these factors can lead to unwanted thermal disturbances. In a cold operating room environment, hypothermia is the usual perioperative consequence; however, hyperthermia is more dangerous and demands immediate diagnosis. Intraoperative hypothermia usually develops in three phases. The first is a rapid decrease in core temperature following anesthetic induction, which mostly results from redistribution of heat from the core thermal compartment to the outer shell of the body. This is followed by a slower, linear reduction in the core temperature that may last several hours. Finally, a core temperature plateau is reached, after which core temperature remains virtually unchanged for the remainder of the procedure. The plateau can be passive or result from re-emergence of thermoregulatory control in patients becoming sufficiently hypothermic. Mild hypothermia in the perioperative period has been associated with adverse outcomes, including impaired drug metabolism, prolonged recovery from anesthesia, cardiac morbidity, coagulopathy, wound infections, and postoperative shivering. Perioperative temperature monitoring devices vary by transducer type and site monitored. More important than the specific device is the site of temperature monitoring. Sites that are accessible during surgery and give an accurate reflection of core temperature include esophageal, nasopharynx, bladder, and rectal sites. Core temperature also may be estimated reasonably using axillary temperature probes except under extreme thermal conditions. Rather than taking a passive approach to thermal management, anesthesiologists need to be proactive in monitoring patients in cold operating rooms and use available technology to prevent gross disturbances in the core temperature. Various methods are available to achieve this. Prewarming patients reduces redistribution hypothermia and is an effective strategy for maintaining intraoperative normothermia. Additionally, forced-air warming and circulating water garments also have been shown to be effective. Heating intravenous fluids does not warm patients, but does prevent fluid-induced hypothermia in patients given large volumes of fluid. This article examined the evolutionary adaptations people possess to combat inadvertent hypothermia and hyperthermia. Because thermal disturbances are associated with severe consequences, the standard of care is to monitor temperature during general anesthesia and to maintain normothermia unless otherwise specifically indicated.  相似文献   

20.

Background

Transurethral resection of the prostate gland with irrigation fluid at room temperature leads to perioperative hypothermia which could give rise to adverse cardiovascular events in the perioperative period. The use of isothermic irrigation fluid reduces but does not eliminate this risk. Routine use of warm intravenous fluids along with isothermic irrigation had not been documented. This study set out to investigate the effect of the use of warm intravenous fluid together with isothermic irrigation fluid on the body temperature in patients undergoing transurethral resection of the prostate gland.

Methods

One hundred and twenty consented patients with obstructing benign prostatic hyperplasia were randomly assigned to one of 3 groups. Group 1 received irrigation and intravenous fluids at room temperature, group 2 received warmed irrigation fluid at 38°C along with intravenous fluid at room temperature while group 3 patients received warmed irrigation fluid and warmed intravenous fluids at 38°C. Their perioperative body temperature changes were monitored, analyzed and compared.

Results

The mean decrease in body temperature at the end of the procedure was significantly greater in group 1 (0.98 ± 0.56°C) than in group 2 (0.42 ± .21°C) (p < 0.001). Significantly more patients in group 1 also experienced shivering. However, in group 3, there was no significant change in the mean body temperature (p > 0.05) and none of them felt cold or shivered.

Conclusion

It is concluded that the use of isothermic irrigation fluid together with warm intravenous fluids during TURP prevents the occurrence of perioperative hypothermia.

Trial registration number

CCT-NAPN-15944  相似文献   

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