低温体外循环心内直视术后体温的观察与护理

为探讨该类手术后患者体温变化的特点,作者将68例患者按不同手术类型分为3组,观察术后7d的体温变化情况。结果显示术后61例（89．7％）患者出现39℃以上高热,体温变化与手术类型无关。提示体外循环术后,体温短时间内变化较大,高热的原因除一般的吸收热外,与手术中低温、复温后体温反跳以及体外循环过程中产生的特殊物质有关。因此,针对不同情况采取及时有效的护理措施是极其重要的。     

两种不同温度灌注液在经皮肾镜手术中的应用效果分析

目的探讨在经皮肾镜手术中应用不同温度灌注液对患者体温变化的影响,并提出相关护理对策。方法63例经皮肾镜手术患者随机分为加温组和常温组,加温组33例,常温组30例,两组均在相同的室温下进行手术。加温组使用温箱加温到37℃的灌注液,常温组使用室温22℃下放置的灌注液。观察两种方法患者术中和术后体温变化。结果两组患者术后与术前基础体温相比,常温组患者在手术开始后60 min、90 min1、20 min及手术结束时体温均显著下降(P<0.05),加温组患者术中各时间点及手术结束时体温均无显著差别。结论术中使用加温灌注液可使经皮肾镜手术患者保持正常体温,避免术中及术后体温下降。     

温热输液及冲洗对人工关节置换术患者术中体温及失血量的影响

目的 明确术中温热输液及冲洗对双侧人工关节置换术患者同期体温及失血量的影响,为临床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（双髋或双侧膝关节置换术）患者,随机分为温热组（n=44）和常温组（n=44）.温热组患者术中输入36.5～37.5 ℃的温热液体（包括库存血）,并采用37 ℃的恒温冲洗液进行术区冲洗;常温组患者术中输入22～24 ℃液体及库存血,并用同温度的冲洗液进行术区冲洗.观察两组患者在麻醉诱导后、麻醉30 min、术中1,2,3 h、术毕即刻6个观察时相体温变化及术中失血量.结果 温热组术中体温变化不明显,常温组体温自术中1 h起开始明显下降,差异有统计学意义（P〈0.05）.温热组体温在术中1,2,3 h及术毕即刻4个观察时相均高于常温组,差异有统计学意义（P〈0.05）;术中2,3 h及术毕即刻,温热组低体温发生率均低于常温组,差异有统计学意义（P〈0.01）;温热组术中失血量为（611.63±392.31）ml,常温组为（923.42±522.50）ml,差异有统计学意义（P〈0.01）.结论 术中应用温热液体有利于维持双侧人工关节置换术患者术中体温恒定,降低低体温发生率,减少术中失血量,术中患者如无低温要求可选择此温度液体.     

保温干预对老年腹部手术患者生命体征的影响

目的观察保温干预对老年腹部手术患者生命体征的影响。方法将>60岁腹部手术患者40例,随机分为保温组(20例)和常温组(20例)。保温组采用控制室温22~24℃,冲洗液、输注液体和血液等加热至37℃;常温组仅控制室温。记录两组患者围手术期收缩压、心率、体温变化和寒战发生情况。结果保温组患者收缩压、心率、体温在入室时、消毒时和手术1h时的差异无统计学意义(P>0.05),而常温组患者收缩压、心率、体温波动明显(P<0.01)。保温组患者寒战、低温(<35℃)的发生率明显低于常温组(P<0.01~0.05)。结论老年患者术中采取有效的保温干预,可有效预防术中低温和促进术后康复。     

常温体外循环心脏手术后补钾方法的探讨

体外循环心内直视手术中普遍采用的低温、冷停跳液心肌保护法,存在很多不足,而90年代以来采用的“含钾温血持续灌注心肌保护法”是一种全新的心肌保护方法[1]。该方法在体外循环心脏手术中维持病人体温在35℃以上,用温血停搏液持续灌注,进行心肌保护,也就是所谓的“温心外科”的概念[2]。为了掌握常温体外循环术后正确补钾的规律,我们对26例患者术后钾出入平衡及血钾变化进行了观察分析,总结了术后补钾的方法,现介绍如下。1资料与方法1.1一般资料1998~2001年26例常温体外循环心脏手术患者,年龄18~66岁,平均43.6岁。男性14例,女性12例。房、…     

两种温度生理盐水在经皮肾镜取石术中的应用效果观察

目的探讨在经皮肾镜取石术中应用两种温度生理盐水作为灌注液对患者体温变化的影响。方法 36例经皮肾镜取石术中患者随机分为加温组19例,常温组17例,加温组使用温箱加温到37℃的生理盐水,常温组使用室温22℃下放置的生理盐水。观察两种方法患者术中和术后心率、体温变化及术中躁动和寒战发生率。结果加温组围手术期的心率的变化较平稳,术前、术中、术后无差异。常温组围手术期的心率波动明显,术前、术中、术后有差异（P〈0.05）。加温组围手术期的体温在正常范围内波动,术前、术中、术后无差异。常温组围手术期的体温下降明显（P〈0.01）。加温组较常温组躁动和寒战的发生率少（P〈0.05）。结论使用加温至37℃的生理盐水作为灌注液可以有效维持患者围手术期的正常心率和体温,减少了躁动和寒战的发生。     

冲洗液温度对经皮肾弹道碎石术患者体温的影响

目的探讨不同温度冲洗液对经皮肾弹道碎石术患者体温的影响。方法将112例行经皮肾手术的患者随机分为2组,52例24℃～26℃(常温)为常温组,60例为加温组。常温组患者术中采用升温毯装置,加温组患者术中采用温液器将0.09%的盐水加温至28℃～30℃,再加升温毯装置,比较2组患者体温及术后寒颤发生率。结果加温组患者的体温在术中和术毕一直都很稳定,与基础值比较无差异(p>0.05);常温组的体温在术中和术毕均低于基础值(p<0.05),且常温组寒颤的发生率高于加温组(p<0.05)。结论加温冲洗液可有效减轻围手术期低温和降低术后寒颤发生率。     

保温干预对老年腹部手术患者体温的影响

目的观察保温干预对老年腹部手术患者体温的影响。方法将40例年龄〉60岁的腹部手术患者随机分为保温组和常温组各20例。保温组采用控制室温22-26℃,冲洗液、输注液体和血液等加热至37℃的保温措施;常温组不实行保温干预。记录2组患者围手术期体温变化和寒战发生情况。结果保温组患者在入室时、术中、离开手术间时的体温比较无显著变化,而常温组患者体温波动明显。保温组患者寒战、低体温（〈35℃）的发生率明显低于常温组。结论对老年患者术中采取有效的保温干预,可有效预防术中低体温和促进术后康复。     

婴幼儿低温体外循环术后体温监测及护理

总结了婴幼儿低温体外循环术后体温监测及护理,包括术后低体温的护理及术后高温的护理。认为低温体外循环下心内直视手术后患儿体温的监测及处理尤为重要。     

保温干预对老年腹部手术患者体温的影响

目的 观察保温干预对老年腹部手术患者体温的影响.方法 将40例年龄>60岁的腹部手术患者随机分为保温组和常温组各20例.保温组采用控制室温22～26℃,冲洗液、输注液体和血液等加热至37℃的保温措施;常温组不实行保温干预.记录2组患者围手术期体温变化和寒战发生情况.结果 保温组患者在入室时、术中、离开手术间时的体温比较无显著变化,而常温组患者体温波动明显.保温组患者寒战、低体温(<35℃)的发生率明显低于常温组.结论 对老年患者术中采取有效的保温干预,可有效预防术中低体温和促进术后康复.     

体外循环心脏手术中体温管理证据汇总

目的 检索并总结体外循环心脏手术中体温管理相关证据,为临床进行规范化的术中低温治疗及复温管理提供依据。方法 应用PICO程式结构化临床问题,确定“体外循环心脏手术患者的体温管理”为研究问题,检索中国指南网,美国指南网,英国国家临床医学研究所指南库,国际指南图书馆,英格兰学院间指南网,Up To Date,BMJ-Best Practice,Cochrane图书馆,PubMed,Web of Science,EMbase,CINAHL,中国生物医学数据库,中国知网,万方医学数据库,医脉通指南网。采用AGREEⅡ、AMSTAR 2、GRADE评价工具对纳入的文献进行质量评价。结果 共纳入文献12篇,包括指南3篇,证据汇总2篇,系统评价7篇,最终提取17条证据,总结出15条审查指标,包括术前评估,预保温,体温监测,浅/中/深低温体外循环手术的降温和复温速率、目标值、温度梯度,复苏时的体温管理等具体内容。结论 建议医务人员结合自身经验、临床情景及患者的意愿应用证据,并及时对证据进行更新,以期临床采用科学的方法进行体外循环手术患者的体温管理,确保体外循环手术患者的安全。     

音乐放松疗法联合物理干预对行腹腔镜胆囊切除术患者围术期低体温状态及应激反应的影响

目的探讨音乐放松疗法联合物理干预措施保温毯对腹腔镜胆囊切除术患者围术期体温、收缩压、舒张压及心率的影响。方法将于某院行腹腔镜胆囊切除术的患者共85例按照抽签法分为两组,其中甲组共有42例,实施常规棉被覆盖保温并通过语言、抚摸等手段予以安慰;乙组共有43例,在围术期实施音乐放松疗法及物理干预措施保温毯进行保温及安慰。对比两组患者在手术开始、手术30 min、手术结束的心率、收缩压、舒张压及体温变化,并记录患者术中低体温及术后寒战发生率,观察术中出血量、术中输液量及手术时间。结果在手术30 min、手术结束时乙组患者心率、舒张压、收缩压低于甲组,体温水平高于甲组(P<0.05);乙组的术中低体温发生率、术后寒战发生率及术中出血量低于甲组(P<0.05);两组的手术时间及术中输液量对比,差异无统计学意义(P>0.05)。结论音乐放松疗法联合物理干预对腹腔镜胆囊切除术患者术中低体温及术后寒战具有预防作用,并可抑制心率、血压的上升,稳定体温水平。     

Volume replacement with a new hydroxyethyl starch preparation (3 percent HES 200/0.5) in heart surgery

In a randomized study including 55 patients undergoing elective aorto-coronary bypass surgery efficacy of a low concentrated hydroxyethylstarch (3% HES 200/0.5) was tested after extracorporeal circulation (ECC). All patients received 1,000 ml autologous washed erythrocytes (cell saver) and 400 ml fresh frozen plasma (FFP). Thereafter patients were randomized into 4 groups. Hemodynamic parameters, laboratory parameters as well as extravascular lung water (EVLW - double indicator dilution technique) were measured before ECC as well as before and after infusion therapy. With regard to hemodynamic efficiency and the change in laboratory data no relevant differences between group I, II and III could be seen. EVLW-measurement demonstrated the lowest increase in lung water after infusion of HES; simultaneously pulmonary gas exchange was less compromised in comparison to the other infusion groups. 3% HES 200/0.5 solution can be considered as an effective volume substitute with short intravascular retention time, which seems to be of advantage in patients coming off extracorporeal circulation.     

Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels

The aim of the study was to assess plasma catecholamine levels in patients undergoing myocardial revascularization and relate them to pulsatile (P) and nonpulsatile (NP) normothermic cardiopulmonary bypass (CPB). Twenty-eight patients were randomly assigned to different CPB management: 15 patients were assigned to group 'P', 13 patients to group 'NP'. During normothermic extracorporeal circulation, group 'P' received pulsatile perfusion, while group 'NP' received nonpulsatile perfusion. Levels of epinephrine and norepinephrine were evaluated during the operation and in the intensive care unit (ICU), at seven time points. Haemodynamic assessment was performed at four time points in the same period. Demographic and surgical data were collected, and the postoperative course was analysed. Epinephrine levels were markedly increased during CPB in both groups, while norepinephrine increased more in group NP in comparison with group P. No significant difference was found in fluid administration, transfusion, drugs usage, or postoperative complications. Normothermic pulsatile CPB seems to achieve reduced levels of norepinephrine. A clinical beneficial effect of this finding was not demonstrated during the study.     

浅低温心脏不停跳心内直视手术215例临床分析

目的：总结215例浅低温体外循环下不停跳心内直视手术的临床应用经验。方法：215例行心脏不停跳心内直视手术病例,并行循环者阻断上下腔静脉而不阻断升主动脉,不使用心脏停跳液;逆行灌注者,阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血,鼻咽温度在（33±1）℃,均在心脏空跳下完成心内直视手术。结果：心脏手术完毕后顺利停机,术后血液动力学平稳,低心输出量综合征发生率低,无1例发生神经系统并发症及空气栓塞,早期死亡率0．93％（2／215）。结论：浅低温体外循环下不停跳心内直视手术技术安全可行,是一种接近生理状态的心肌保护方法,可应用于绝大部份心内直视手术。     

Platelet function test HemoSTATUS 2: tool or toy for an optimized management of hemostasis?

BACKGROUND: Bleeding after open heart surgery is a common but unintended problem, which is unequivocally related to platelet function. The target of our study was to correlate platelet activation levels and postoperative blood loss as well as the predictive power of measurements focusing on postoperative hemostasis. MATERIALS AND METHODS: The prospective trial comprised 100 patients (mean age: 64.3 years, 68% male) undergoing cardiac surgery. Platelet activation was measured by the new and modified HemoSTATUS test. Blood samples were drawn pre-, intra- and postoperatively. Standard hemostasis tests, including activated clotting time (ACT), partial thromboplastin time (PTT), hemoglobin, platelet count, antithrombin III (AT III) and fibrinogen, were measured according to the clinical routine. Blood loss and consumed blood products were documented up to the 24th hour after the operation. RESULTS: Platelet activation showed a typical change, with lowest levels after the end of extracorporeal circulation and a restitution to preoperative levels after 24 h. Mean blood loss was 461 ml. Statistical analysis showed neither a correlation to the platelet activation measurements nor to low pre-, intra- or postoperative levels. CONCLUSION: The HemoSTATUS platelet function test is not suitable for a reliable monitoring of platelet pathophysiology and patient outcome after extracorporeal circulation. Furthermore, no correlation of preoperative platelet activation and blood loss could be shown.     

非体外与体外循环冠状动脉旁路移植术的效果及成本比较

[目的]比较非体外循环冠状动脉旁路移植术(OPCAB)与体外循环冠状动脉旁路移植术(CCABG)的效果和成本。[方法]对2003年1月—2005年8月在我院行OPCAB的病人45例及CCABG的病人35例进行回顾性非随机临床对照,对两组病例在手术时间、输血量及出血量、气管插管及留住ICU时间、术后住院时间、并发症、总住院费用等方面进行对比总结。[结果]两组病人的手术时间有统计学意义(P<0.05),输血量、出血量、留住ICU时间、并发症、总住院费用等OPCAB组均少于CCABG组,但无统计学意义(P>0.05)。在气管插管时间、术后住院时间OPCAB组明显短于CCABG组,有统计学意义(P<0.01)。[结论]OPCAB组比CCABG组术中心脏创伤小,术后心脏功能恢复快,并发症少,并能缩短ICU留住时间和住院时间,减少住院费用,降低医疗成本,病人近期生活质量提高。     

舒适护理在前列腺汽化电切术患者中的应用

目的探讨舒适护理在前列腺汽化电切术患者中的应用效果。方法按入院次序将640例行前列腺汽化电切术患者分为对照组和观察组,每组各320例。对照组采用常规护理,观察组采用舒适护理。比较两组患者手术时间及术中出血量、血压、心率和术后畏寒症等观察指标的差异。结果观察组患者的手术时间、术中出血量和术后畏寒发生率低于对照组（均P〈0.05）。观察组患者术中血压与心率较其基础值无明显变化（均P〉0.05）,对照组则有明显的升高（均P〈0.05）,两组术中血压与心率比较,差异具有统计学意义（均P〈0.05）。结论舒适护理可使患者身心处于最佳状态,从而积极主动配合手术治疗,进而提高了手术效果,同时降低了术后并发症的发生,提高了护理质量。     

The nature and origin of hyperamylasemia following open-heart surgery with extracorporeal circulation

The nature of the postoperative hyperamylasemia in 27 patients undergoing open-heart surgery was investigated. An increase in serum amylase activity was found m 56% of the patients. Isoamylase analysis revealed that the rise was in the salivary-type isoamylase m all of these patients. Since the level of serum amylase activity was increased in the postoperative state with prolongation of extracorporeal circulation, it is conceivable that cellular hypoxia due to inadequate tissue perfusion may cause disturbances in cellular metabolism with a release of intracellular amylase.The finding of the salivary-type amylase in normal lung tissue, transient salivary-type hyperamylasemia in acute respiratory distress and increased amylase activity of the salivary-type in serum specimens from the left atrium compared to those from the right ventricle suggest that the origin of the amylase responsible for the transient postoperative hyperamylasemia in the salivary-type is due to the amylase released from lung tissues under hypoxia during and after operation.     

3个月龄患儿完全性肺静脉异位引流的围术期护理

目的探讨3个月龄患儿完全性肺静脉异位引流围术期的护理,提高术前术后的监护水平及护理问题的解决方法。方法本院完成了27例3个月以内的完全性肺静脉异位引流患儿在低温体外循环下矫治术,术后通过维护循环功能的稳定,预防低心排和心包填塞;采取综合措施预防肺动脉高压;积极防治呼吸机相关性肺炎以及术后体温维持、营养支持等治疗护理措施。结果本组5例患儿延迟关胸,术后21～56 h在床边顺利关胸,其中术后并发肺出血1例,经应用东莨菪碱治疗、增加呼吸机PEEP＋5～＋8 H2O, 加强呼吸道管理后好转并治愈;另有4例患儿发生肺部感染,经抗感染后痊愈;无1例出现严重心律失常（可能与手术方式有关）; 27例患儿除1例术后21 h因低心排抢救无效死亡,其余26例经精心治疗和护理,均痊愈出院。结论3个月以内完全性肺静脉异位引流患儿病情严重,术后护理难度大,通过精心护理可明显提高低龄患儿手术成功率和治愈率,降低术后并发症。