术中保温对患者核心体温的影响

目的　探讨术中保温对患者核心体温的影响。方法　将 4 0例择期全麻下行腹部手术的患者随机分为对照组和加温组 ,各 2 0例。对照组患者术中不采用任何升温装置 ,加温组患者术中采用输液加温器及充气升温毯加温。观察两组患者术中核心体温、失血量和输血量、拔管时间及术后寒战发生率。结果　术毕核心温度 ,加温组为 ( 36 4± 0 4 )℃ ,对照组为 ( 35 3± 0 5 )℃ (t =7 5 4 7,P <0 0 1)。两组患者术中失血量和输血量差异无显著性 (P >0 0 5 )。加温组拔管时间为 ( 18± 6 )min ,短于对照组的 ( 2 6± 10 )min(t=- 3 36 4 ,P =0 0 0 2 )。对照组有 6例患者发生术后寒战 ( 30 % ) ,加温组无术后寒战发生 ( 0 % ,χ2 =7 0 5 9,P =0 0 0 8)。结论　术中采用输液加温器和温毯 ,可有效地维持患者正常体温 ( 36 0℃～ 37 0℃ ) ,从而缩短拔管时间、减少术后寒战发生。     

术前预加温维持患者核心体温有效性的Meta分析

目的:系统评价术前预加温维持术中核心体温的有效性,为围手术期体温管理提供临床依据。方法:计算机检索PubMed、Web of Science、the Cochrane Library、EMBACE、CINAHL、中国知网、万方数据库、维普、中国生物医学文献数据库,全面搜集术前预加温对手术患者术中核心体温影响的随机对照试验(randomized controlled trial,RCT),检索时限为2000年1月至2019年4月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献,评价纳入文献质量,并进行数据提取,采用RevMan 5.3软件进行Meta分析。结果:纳入14个RCT,共902例患者。Meta分析结果显示:术前预加温组在麻醉诱导后30、60、90 min时以及手术结束时患者的核心体温明显高于对照组,而在术中和术后低体温的发生率方面则低于对照组,差异有统计学意义(P<0.05)。但两组在术后寒战的发生率方面差异无统计学意义(P>0.05)。结论:术前实施预加温能有效提升患者术中的核心体温,降低低体温的发生率。     

不同保温措施对胃癌根治术患者体温变化的影响

目的探讨胃癌根治手术中不同的保温方式对患者体温的影响。方法将2010-01—2011-11接受胃癌根治术患者240例按照随机分组法随机分为薄面被,充气式加温毯和综合加温3组各80例,采用上述不同方法对手术后的患者进行加温。分别测定患者进入手术室时、术中30、90、120、180 min以及手术结束时的体温。结果薄棉被组、充气式加温毯组和综合加温组患者各个时间段的体温差异均有统计学意义(P<0.05)。结论较之薄棉被保温及充气式加温毯等保温方法相比,综合保温方式效果最好。     

体温保护对剖腹胃癌根治术患者快速康复的影响

目的观察体温保护对剖腹胃癌根治术患者快速康复的影响。方法选择剖腹胃癌根治术患者60例,男39例,女21例,年龄45~76岁,ASAⅠ或Ⅱ级,随机分成升温组和对照组,每组30例。升温组患者入室后给予体温保护,开启升温毯至42℃直至患者离开PACU,暴露皮肤均予以干净敷料覆盖,输注液体(包括复方乳酸钠、羟乙基淀粉及红细胞悬液)和腹腔冲洗液体均加热至40℃,呼吸过滤器安置于气管导管处。对照组患者未给予特殊保温加热措施。手术室温度调节至21~23℃。采用红外线鼓膜耳温计观察并记录两组患者入室时(T_1)、麻醉诱导前(T_2)、术中(T_3)、关腹(T_4)、拔管(T_5)、离开PACU(T_6)时患者的核心温度。观察并记录患者麻醉时间、手术时间、手术室温度、术中出血量、术中输血量、麻醉药物用量、总输液量和腹腔液体冲洗量、拔管时间和住院时间等;记录术后寒战、切口感染的发生情况。结果与T_1时比较,T_2~T_6时两组核心温度均明显降低,且升温组核心温度明显高于对照组(P0.05)。升温组术中出血量、术中输血量明显少于,拔管时间和住院时间明显短于,术后寒战及切口感染的发生率明显低于对照组(P0.05);两组麻醉时间、手术时间、手术室温度、麻醉药物用量、总输液量、腹腔冲洗液量差异无统计学意义。结论多方法联合体温保护措施,能明显降低剖腹胃癌根治术患者围术期低体温的发生,有利于患者术后康复。     

术中保温对食管癌根治术患者凝血功能的影响

目的观察术中保温对食管癌根治术患者凝血功能的影响。方法择期行食管癌根治术患者16例,ASAI 或Ⅱ级,随机分为对照组(NT 组)和保温组(HT 组),每组8例。HT 组麻醉诱导前对下半身加温(设定温度38℃)45min,麻醉诱导后继续对下半身持续加温(设定温度43℃)。术中每隔10min 记录鼓膜温度。分别测定麻醉诱导前(T_0)和麻醉诱导后150min(T_1)时血栓弹力图(TEG), 同时测定标准温度(37℃)和实际中心体温校正的 TEG。结果 T_1时 NT 组鼓膜温度[(34.7±0.4)℃] 低于 HT 组[(36.5±0.3)℃](P＜0.01)。与37℃下比较,中心体温下 NT 组 T_1时反应时间(R)、血凝块形成时间(K)延长,α角减小(P＜0.05),HT 组 TEG 各指标差异无统计学意义(P＞0.05)；与 NT 组比较,HT 组 T_1时中心体温下 R、K 缩短,α角增大(P＜0.01),最大幅度差异无统计学意义。结论食管癌根治术中保温可改善患者的凝血功能。     

经尿道前列腺电切术中保温护理预防低温寒战效果观察

目的观察经尿道前列腺电切术中保温护理预防低温寒战的效果。方法将80例经尿道前列腺电切术患者随机分为2组,每组40例。对照组术中灌洗过程中采用常规护理措施;观察组在常规护理的基础上联合动态调节室温、体表覆盖升温毯、加温灌洗液等保温护理措施。观察2组患者术前、术中30 min、术毕时体温波动情况及术中低温、寒战发生率和术后感染等不良反应情况。结果 2组前体温比较,差异无统计学意义(P>0.05)。观察组术中30 min、术毕体温均高于对照组,差异有统计学意义(p<0.05)。观察组术中低温、寒战发生率及术后感染率均低于对照组,差异有统计学意义(P<0.05)。结论经尿道前列腺电切术中采用保温措施,可保持患者体温稳定,降低术中低温、寒战及术后感染等不良反应发生率。     

腰硬联合阻滞麻醉患者术中水循环式保温毯的应用

目的探讨水循环式保温毯预防手术患者低体温的干预效果。方法将腰硬联合阻滞麻醉的住院手术患者100例随机分为两组。对照组(n=50)按常规护理,手术期间盖太空被。观察组(n=50)应用水循环式保温毯预防低体温,即患者除盖太空被外,卧于有水循环式保温毯覆盖的手术床上。结果观察组麻醉后、术中1h、术毕、出室前4个时间点的肛温高于同期对照组;观察组的术中低体温与寒战发生率、出院前手术部位感染发生率显著低于对照组;观察组舒适度评分显著高于对照组(P0.05,P0.01)。结论水循环式保温毯能有效预防手术患者低体温和寒战的发生。     

库血加温输注对术中患者体温的影响

目的探讨库血加温输注对手术患者体温的影响.方法将100例外科手术患者随机分为观察组和对照组,各50例.对照组按常规输血,观察组输血前将库血置37 ℃水浴箱10 min,分别于麻醉前,麻醉后30、60、120 min,术毕,术后30、60 min观察患者腋温和寒战发生情况.结果两组患者麻醉后60 min至术后60 min不同时间腋温比较,差异有显著性意义(均P＜0.01);两组寒战总发生率比较,差异有显著性意义(P＜0.01).结论库血加温输注可以预防患者术中体温下降及寒战的发生,提高患者的手术耐受性.     

循环温毯仪对胃癌患者术中体温的影响

术中低温是围术期常见的现象，会引起一系列不良后果，因此有必要对患者采取保温措施。循环温毯仪是一种水温受电脑监控的循环水毯。本文目的是观察全身麻醉下胃癌患者术中低温发生情况，评估循环温毯仪对维持术中正常体温的效果，并探讨维持术中正常体温对患者的临床意义。     

术中积极保温干预对剖宫产术后手术源性低体温的影响

目的 探讨术中积极保温措施在预防剖宫产患者术后手术源性低体温中的作用。方法 回顾性分析本院2022年1月至2022年12月98例行剖宫产者临床资料,其中49例患者于术中实施常规保温者为对照组;49例于术中积极实施保温措施者为观察组。比较两组患者不同时间节点时体温状况;比较两组患者手术期间血压（收缩压、舒张压）和心率水平。比较两组患者术后状况;比较两组手术期间寒颤发生率。结果 观察组患者产后10 min、30 min、60 min时体温分别为（35.17±1.35）℃、（36.21±0.53）℃、（37.07±0.31）℃,较对照组产后相应时间点时体温（34.02±1.08）℃、（35.23±0.32）℃、（36.12±0.36）℃高,P<0.05。观察组手术期间收缩压、舒张压、心率水平均明显低于对照组,P<0.05。观察组患者手术期间寒颤发生率明显低于对照组,P<0.05。观察组产后出血量明显少于对照组,首次下床活动时间和首次肛门排气时间以及住院时间明显短于对照组,P<0.05。结论 术中积极采取保温措施不仅可降低剖宫产患者寒颤发生率,有助于维持患者体温的稳定性...     

术前口服碳水化合物对胃癌术后胰岛素抵抗影响的机制研究

目的 评价胃癌患者术前口服碳水化合物对术后胰岛素抵抗的影响并探讨其可能机制.方法 将2011年4-10月连续入院且符合入组标准的60例胃癌患者按照随机双盲原则分为口服碳水化合物组和口服安慰剂组,术前4h监测患者静息能量消耗(REE)及呼吸商,并抽取空腹血,测定血糖、胰岛素及三酰甘油,麻醉前2～3h口服500 ml碳水化合物(或安慰剂),2组患者均在硬膜外加静脉复合全身麻醉下行根治性远端胃癌切除术,开腹即刻及关腹前取腹直肌组织并固定,术后即刻抽血测定血糖、胰岛素及三酰甘油,并监测术后REE及呼吸商,比较2组患者手术前后胰岛素抵抗指数、三酰甘油、REE及呼吸商的变化,透射电镜观察2组患者腹直肌线粒体超微结构变化.结果 共48例患者完成试验(口服碳水化合物组和口服安慰剂组各24例),口服安慰剂组和口服碳水化合物组术后胰岛素抵抗指数分别为12.68±3.13和5.67±1.40(t=6.646,P=0.003);静息能量分别为(1458±169)、(1341±110) kcal/d(t=2.851,P=0.046);呼吸商分别为0.73 ±0.42和0.79 ±0.22(t=6.546,P=0.041);血三酰甘油水平分别为(0.53±0.24)、(1.04±0.97)g/L(t =2.542,P=0.006);腹直肌线粒体损伤指数分别为1.14 ±0.33和0.92 ±0.19(t =2.730,P=0.028),差异均有统计学意义.口服安慰剂组术后线粒体较术前明显肿胀,嵴膜不清晰.结论 术前口服碳水化合物可降低胃癌根治术患者术后胰岛素抵抗,减少静息能量消耗,改善物质代谢;可能机制与口服碳水化合物促进胰岛素释放,保护线粒体功能有关.     

Effects of surgical site and inspired gas warming devices on body temperature during lower abdominal and thoracic surgery

To evaluate the effects of surgical site and inspired gas warming and humidifying devices on body temperature, we studied rectal, tympanic membrane, and esophageal temperature changes in 48 patients. The patients were divided into 4 groups (n = 12), according to surgical site, lower abdominal surgery and thoracic surgery, and according to the warming device used, heat and moisture exchanger (ThermoVent 600) and heated humidifier (Cascade 1). The heated humidifier was controlled to warm inspired gases to about 35°C. All body temperatures fell significantly during surgery. There was no difference in the tympanic membrane and esophageal temperature declines between the two surgical sites, but the decline in rectal temperature was larger in the lower abdominal surgery than in the thoracic surgery. At the end of surgery, all temperatures returned to the value before surgery, and the rectal and tympanic membrane temperatures even exceeded them. There was no difference between the effects of the ThermoVent 600 and Cascade 1. These results suggest that rectal temperature is influenced by the ambient temperature during lower abdominal surgery and that warming and humidifying devices for inspired gases do not prevent, but can restore the decline in body temperature during lower abdominal and thoracic surgery. The heated humidifier showed no advantage over the heat and moisture exchanger in our study.(Harioka T, Sone T, Nomura K, et al.: Effects of surgical site and inspired gas warming devices on body temperature during lower abdominal and thoracic surgery. J Anesth 6: 467–473, 1992)     

Effects of a circulating-water garment and forced-air warming on body heat content and core temperature

BACKGROUND: Forced-air warming is sometimes unable to maintain perioperative normothermia. Therefore, the authors compared heat transfer, regional heat distribution, and core rewarming of forced-air warming with a novel circulating-water garment. METHODS: Nine volunteers were each evaluated on two randomly ordered study days. They were anesthetized and cooled to a core temperature near 34 degrees C. The volunteers were subsequently warmed for 2.5 h with either a circulating-water garment or a forced-air cover. Overall, heat balance was determined from the difference between cutaneous heat loss (thermal flux transducers) and metabolic heat production (oxygen consumption). Average arm and leg (peripheral) tissue temperatures were determined from 18 intramuscular needle thermocouples, 15 skin thermal flux transducers, and "deep" hand and foot thermometers. RESULTS: Heat production (approximately 60 kcal/h) and loss (approximately 45 kcal/h) were similar with each treatment before warming. The increases in heat transfer across anterior portions of the skin surface were similar with each warming system (approximately 65 kcal/h). Forced-air warming had no effect on posterior heat transfer, whereas circulating-water transferred 21+/-9 kcal/h through the posterior skin surface after a half hour of warming. Over 2.5 h, circulating water thus increased body heat content 56% more than forced air. Core temperatures thus increased faster than with circulating water than forced air, especially during the first hour, with the result that core temperature was 1.1 degrees +/- 0.7 degrees C greater after 2.5 h (P < 0.001). Peripheral tissue heat content increased twice as much as core heat content with each device, but the core-to-peripheral tissue temperature gradient remained positive throughout the study. CONCLUSIONS: The circulating-water system transferred more heat than forced air, with the difference resulting largely from posterior heating. Circulating water rewarmed patients 0.4 degrees C/h faster than forced air. A substantial peripheral-to-core tissue temperature gradient with each device indicated that peripheral tissues insulated the core, thus slowing heat transfer.     

Postoperative changes in body composition after gastrectomy

Nutritional status is one of the most important clinical determinants of outcome after gastrectomy. The aim of this study was to compare changes in the body composition of patients undergoing laparoscopyassisted gastrectomy (LAG), distal gastrectomy (DG), or total gastrectomy (TG). Total body protein and fat mass were measured by performing a multifrequency bioelectrical impedance analysis using an inBody II machine (Biospace, Tokyo, Japan) in 108 patients (72 men, 36 women) who had undergone LAG (n = 24), DG (n = 39), or TG (n = 45). Changes between the preoperative data and results obtained on postoperative day 14 and 6 months after surgery were then evaluated. The mean preoperative body weight of the subjects was 57.6 +- 10.7 kg, the mean body mass index was 22.5 +- 3.4 kg/m², and the mean fat % was 24% +- 7%. In the immediate postoperative period (14 days), the body weight loss in the LAG group was significantly lower than in the DG and TG groups (2.5 +- 0.9 kg vs. 3.5 +- 1.8 kg and 4.0 +- 1.9 kg, respectively; P +- 0.0001). The body composition studies demonstrated a loss of total body protein rather than fat mass. Six months after surgery, body weight was not significantly different from preoperative values in the LAG and DG groups (-1.2 +- 3.8 kg and -1.8 +- 4.7 kg, respectively), but had decreased by 8.9 +- 4.9 kg in the TG group (P = 0.0003). A body composition analysis revealed a loss of fat mass in the DG and TG groups. The patients who underwent gastrectomy lost body protein mass during the early postoperative period. The type and extent of surgery has an effect on long-term body mass and composition. Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone gastrectomy. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (poster presentation). A Grant-in-Aid for Scientific Research (C) from the Japan Society for the Promotion of Science supported this study.     

Comparison of body temperature changes during laparoscopic and open cholecystectomy

Background: Prevention of hypothermia during abdominal surgery by insulating or heat-transferring methods has been the subject of numerous investigations. This study approaches the problem from a less discussed point of view, i.e. the effect of different surgical techniques on body temperature changes.
Methods: Body temperature was measured at 3 core and 6 skin points in 40 patients scheduled for cholecystectomy through open laparotomy or laparoscopy with pneumoperitoneum created and maintained with unwarmed carbon dioxide (CO₂) insufflation. End-tidal CO₂ was kept constant by adjustments of respiratory frequency. Anaesthesia, intravenous infusions, and draping of the patients were standardized.
Results: During the first 1 h of anaesthesia core temperatures decreased approximately by 0.7˚C and distal skin temperatures increased by 7˚C in both groups. At the end of surgery heat balance was similar in both groups. An increase of 2.5 1 min^-1 in respiratory minute volume was needed to control end-tidal CO₂ levels in the laparoscopy group during pneumoperitoneum, which was maintained with a CO₂ flow of 1.2 l-min^-1 through the abdominal cavity.
Conclusion: Laparoscopic technique with unwarmed carbon dioxide insufflation does not offer any advantage in terms of body temperature changes when compared to open surgery.     

胃癌术中脾门损伤的处理

目的 探讨胃癌根治术中脾门损伤的处理方法,降低脾脏切除率.方法 回顾分析2008年3月至2014年3月行胃癌手术中发生脾门损伤的6例患者病例资料,术中全部采用血管缝线缝合法进行处理.结果 经过缝合法处理后,全部患者均得到有效的止血,部分患者出现脾脏节段性缺血,无脾脏切除病例;全组术后均未出现与脾脏损伤相关的并发症.结论 胃癌术中脾门损伤并非脾脏切除的指针,采用血管缝线缝合法来保脾,方法简单易行,效果确切.     

Energy loss by the body during gastrectomy

A method for calculation of the loss of energy by an organism of a patient at the time of gastric resection is presented. It is shown that for the 2h of operation, a patient losses the amount of energy which is almost equal to the basal metabolism for 24 hours.     

术前心率变异性参数预测机器人胃癌术后中重度疼痛的效果

目的 探讨术前心率变异性（HRV）参数用于预测机器人胃癌术后中重度疼痛（NRS评分>3分）的效果。
方法 选择2019年12月至2022年08月行机器人胃癌根治术的患者125例,男80例,女45例,年龄≥18岁,BMI≥18 kg/m²,ASA Ⅰ—Ⅲ级。应用穿戴式动态心电记录仪观察术前24 h HRV参数：正常RR间期的标准差（SDNN）、每5分钟平均RR间期的标准差（SDANN）、相邻RR间期差值的均方根（RMSSD）、每5分钟NN间期标准差的平均值（SDNNIDX）、相邻RR间期相差>50 ms的个数占总心跳次数的百分比（pNN50）、低频功率（LF）、高频功率（HF）、LF/HF,并收集一般资料、术中指标和术后第1天白细胞计数（WBC）、血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）浓度。根据术后72 h内数字评分量表（NRS）的疼痛评分的最大值将患者为两组：NRS评分≤3分组和NRS评分＞3分组。筛选术后中重度疼痛发生的预测因素,采用受试者工作特征（ROC）曲线评估HRV参数预测机器人胃癌术后中重度疼痛的效能。
结果 有48例（38.4%）患者术后72 h内至少出现一次中重度疼痛。多因素Logistic回归分析显示：HF升高（OR=0.991,95%CI 0.985～0.996）是术后发生中重度疼痛的独立预测因素。其预测术后中重度疼痛发生的AUC为0.928（95%CI 0.885～0.971）,最佳截断值为455.55 ms2,敏感性79.2%,特异性93.7%。
结论 术前自主神经功能状态与机器人胃癌术后中重度疼痛的发生密切相关,HRV参数中的HF对术后中重度疼痛发生具有一定预测价值。     

Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate

Objectives. To determine the effect irrigation fluid temperature has on core body temperature changes in patients undergoing transurethral resection of the prostate (TURP).Methods. Fifty-six male patients (mean age 71.2 ± 8.2 years) scheduled for TURP were enrolled in the study. Patients were randomized to one of two groups. Group 1 consisted of 27 patients who received room temperature irrigation fluid (70°F) throughout TURP; group 2 consisted of 29 patients whose procedure was performed with warmed irrigation fluid (91.5°F). The irrigation fluid used for both groups was glycine. The baseline temperature, final temperature, total time in the operating room, and amount of irrigation fluid used during the procedure were recorded for each patient.Results. No significant difference in the average time spent in the operating room or in the total irrigation fluid used between the two groups was observed. Of the 27 patients who received room temperature irrigation fluid, 15 (55.6%) had a decrease in body temperature. A decrease in temperature was observed in 21 (72.4%) of the 29 patients who received warm irrigation fluid. Groups 1 and 2 had 12 (44.4%) of 27 and 8 (27.6%) of 29 patients, respectively, who demonstrated an elevation in their core body temperature.Conclusions. The results of our study suggest that irrigation fluid temperature is not a factor responsible for altering the core body temperature in patients undergoing TURP.