围术期低体温护理的研究进展

综述了导致围术期低体温的原因,低体温对机体产生的影响.针对性地采取围术期低体温的综合护理措施等研究进展.     

加温输液围术期临床应用进展

围术期低体温可导致许多并发症的发生，包括凝血功能障碍、心脏病及手术伤口感染抵抗力降低等。为预防围术期低体温，常采取加温输液以保持体温，对于预防输液后体温降低，以及引起相关不良反应方面具有深远的意义。     

老年膝关节置换术患者围术期主动保温方案的制订与实施

目的 制订与实施膝关节置换术老年患者围术期主动保温方案，探讨其应用效果。方法 将210例膝关节置换术患者按照随机数字表法分为三组各70例。对照1组采用常规保温措施，对照2组在其基础上增加术中主动保温，观察组采用制订的围术期主动保温方案进行干预。结果 三组术中、术后低体温发生率，拔管及苏醒时间，术后寒战发生率比较，差异有统计学意义（均P<0.05）。结论 老年膝关节置换术患者围术期主动保温方案能够有效降低围术期低体温发生率，保障患者安全。     

围术期低体温与麻醉管理

麻醉和手术过程中,中枢神经的体温调节功能受到干扰,多种因素影响人体热平衡,形成了围术期常见的低体温.低体温造成机体生理功能紊乱,与许多围术期并发症有关.采取有效措施防治低体温是现代麻醉管理的重要环节.     

老年结直肠手术患者围手术期体温对压疮发生风险的影响分析

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。     

预防前列腺汽化电切术中低体温的保暖护理措施

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。     

基于循证构建围手术期低体温预防护理质量敏感指标体系

目的 基于循证方法构建围手术期低体温预防的护理质量敏感指标体系，为护理质量评价提供依据。 方法 在预防围手术期患者低体温的最佳证据总结和证据应用的基础上，形成以“结构-过程-结果”模式为框架的条目。经过2轮专家函询，确定最终指标。 结果 最终形成包括3个一级指标、8个二级指标、35个三级指标的围手术期低体温预防的护理敏感指标体系。 结论 构建的围手术期低体温预防护理质量敏感指标体系具有科学性，可用于评价围手术期低体温预防的护理质量。     

围术期低体温有效预防策略的研究进展

正人体正常体温调节系统由温度感受器、体温调节中枢及效应器三部分组成。人体核心体温受严密调控维持在37 ℃左右,外周体温较核心体温低2～4 ℃。与有目的的治疗性低体温不同,非医疗计划导致的围术期机体核心体温低于36.0 ℃称为围术期意外低体温(inadvertent perioperative hypothermia, IPH)[1],又称围术期低体温。IPH在各类手术中发生率为7%～90%[1-2],可导致心血管事件[3]、术后感染[4]、     

预防围术期低体温的研究进展

体温是是生命体征之一,体温的维持在围手术期间起着重要作用。低体温是指低于36℃,临床上一般将中心体温34℃-36℃称为轻度低体温。围术期低体温是手术过程中极易造成的一种现象,在患者手术过程中中,50%-70%患者术中会发生低体温。手术中患者出现低体温,还会引起很多其他的并发症,原来所有的医务人员都未引起重视,近年来随着     

中西医防治围术期低体温的研究进展

围术期患者常发生低体温。目前防治围术期低体温(IPH)多采用物理保温、升温的方法。中医认为,体温降低与机体阳气温煦失司、营卫失调、阴阳失衡以及脏腑功能受损有关。从创伤出血证候出发,围术期发生的低体温与寒邪内侵导致的阳气不舒关系最为密切。按照中医的阳气不舒理论进行论治可采用调畅气血、舒展全身阳气的方法防治术中、术后低体温,方法包括艾灸、穴位贴敷、穴位按摩、中药热熨等。本文对中医、西医防治IPH的进展进行综述,并展望中西医结合防治IPH的前景,以期为预防IPH提供更加有效的方法,达到促进患者快速康复的目的。     

低体温对患者围手术期出血及凝血功能的影响

背景 围手术期低体温是麻醉过程中的常见并发症并对患者产生一系列副作用,然而低体温对患者出血和凝血功能方面的作用及机制尚不明确. 目的 综述围手术期低体温对出血及凝血机制的研究进展. 内容 从临床和基础研究角度出发,针对围手术期出血和凝血功能两个层面,阐述低体温对出血、凝血平衡的影响. 趋向 围手术期低体温对患者出血及凝血功能诸多层面存在影响,需要进一步研究支持.     

预保温在防治围手术期低体温中的作用及其研究进展

背景 围手术期意外低体温是手术患者常见的并发症,预保温作为一项行之有效的保温方式,已经成为国外体温保护的推荐措施,然而在国内的临床研究和工作中并没有引起重视. 目的 对预保温在防治围手术期低体温中的作用及其研究进展进行综述,为围手术期体温保护提供参考. 内容 概述预保温的理论基础及由来,总结预保温在当前临床研究中的应用及其效果,阐述包括预保温的设备、温度设置、保温时间等在内的研究进展. 趋向 预保温应在临床中得到更多应用,其策略的规范化和最优化需更多进一步的临床研究支持.     

肩关节镜术中低体温情况的观察性研究

目的观察肩关节镜术中围手术期低体温的发生率以及影响因素。 方法回顾性分析2020年6月至2020年9月以及2020年12月至2021年2月于本院治疗的161例肩关节镜手术患者,排除1例年龄过小、2例合并颈椎病、3例数据不全的患者,实际入组参与研究患者155例,其中左侧肩66例、右侧肩89例;男50例、女105例（男：女=1:2）;平均年龄（58.87±11.50）岁（19~79岁）。126例肩袖损伤,9例肩关节不稳定,1例肱骨大结节骨折,16例冻结肩,3例钙化性肌腱炎。记录患者的基本资料、手术时长、麻醉分级、麻醉方式、术中体温保护措施、手术室的温度,对这些数据进行统计学的分析,评估围手术期低体温的发生率以及危险因素。 结果针对155例肩关节镜患者的资料分析结果可见手术开始时有43例患者的体温均处于低体温状态,112例患者处于正常范畴,低体温发生率为27.74%。而在手术结束时出现低体温状态的患者有62例,而93例患者处于正常范畴,术后的低体温发生率为40%。所有的低体温状态均处于轻度的围手术期低体温范畴。麻醉后出现低体温的患者中,性别和BMI的比值差异具有统计学意义,而术中及结束时出现低温的情况则与年龄、性别、手术时间、灌注量和保温措施相关。并且当手术时间超过90 min后,灌注液对核心体温的影响起到了主导作用。 结论肩关节镜手术中多种因素与围手术期低体温相关,常温灌注液体也对核心体温起到一定的影响作用,导致围手术期低体温的发生。     

"Pre-warming" - how can perioperative hypothermia be avoided?

Perioperative hypothermia is a well known problem in general and neuroaxial anaesthesia. Some years ago effective therapeutic means as e. g. forced air systems and infusion heaters were introduced into clinical routine. If these systems are used intraoperatively only, hypothermia is solely treated symptomatically. Pathophysiologic cause of perioperative hypothermia mainly is an initial drop of core-temperature due to redistribution of heat-energy. On this basis Camus and Sessler introduced pre-warming. Patients are warmed with forced-air systems prior to induction of anaesthesia. Thus the drop in core-temperature caused by redistribution is minimized. Pre-warming is a simple, effective and cheap way to reduce perioperative hypothermia. This article gives a short overview on pathophysiology of perioperative hypothermia. Published clinical experiences are discussed and practical guidelines for everyday-use given.     

围术期低体温的研究进展

一、正常的体温调节 体温调节系统是由感受传入、中枢控制和传出效应互相联系而组成的一个反馈系统^[1-2]。温度感受器分布于全身许多部位,冷感受器通过A-delta纤维传送信号,而热感受器通过C纤维传送信号。在体温自主调节中,皮肤、腹腔和胸腔、脊髓、下丘脑和大脑其他部位传入信号各约占20％,而在行为调节中,主要依赖皮肤温度^[1,2,3]。     

Perioperative hypothermia does not enhance the risk of cancer dissemination

BACKGROUND: Resistance to cancer metastasis is mediated by host immunity, and mild perioperative hypothermia impairs immune function. We tested the hypothesis that mild perioperative hypothermia increases the risk of cancer recurrence and subsequent mortality METHODS: In a 5- to 9-year follow-up of 140 cancer patients enrolled in a study demonstrating that 2 degrees C mild perioperative hypothermia triples wound infection risk, tumor characteristics likely to influence recurrence, patient outcome, and current health status were determined. Primary outcomes were tumor recurrence and all-cause mortality. RESULTS: Tumor status in the groups was similar and included Duke's and TNM classifications, preoperative carcinoembryonic antigen concentration, histologic differentiation, numbers of nodes biopsied and positive nodes, blood vessel invasion, and adhesion of tumor to adjacent organs. Cancer-free and overall survival rates were similar in normothermic and hypothermic patients. These data provide 80% power for detecting a 25% difference between the groups. CONCLUSIONS: Mild perioperative hypothermia did not increase recurrent tumors, cancer death, or all-cause mortality.     

Perioperative Hypothermie

Mild perioperative hypothermia is a common complication of anesthesia and surgery associated with several adverse effects including impaired wound healing and more frequently leads to wound infections. Perioperative hypothermia affects the hemostasis and various immune functions and therefore interferes with the initial phases of the wound healing process. Furthermore, perioperative hypothermia contributes to wound complications by inhibition of deposition of collagen and prolongation of postoperative catabolism. Wound complications prolong hospitalization and substantially increase medical costs. Thus, maintaining normothermia perioperatively is essential to reduce the number of wound complications.     

Mild hypothermia does not increase bacterial proliferation on implanted vascular grafts

BACKGROUND: Mild hypothermia may offer protection against spinal cord ischemia during aortic surgery. However, hypothermia also promotes postoperative infection via two mechanisms: peripheral vasoconstriction and impairment of various immune functions. If mild hypothermia aggravates graft infections, immune function impairment would presumably be the most important factor because thermoregulatory vasoconstriction does not appreciably reduce aortic blood flow. We therefore tested the hypothesis that resistance to vascular graft infection is not reduced by mild perioperative hypothermia in dogs. METHODS: After colonization with a solution of Staphylococcus epidermidis, prostheses were used to replace the infrarenal aorta in 20 dogs. During surgery, the dogs were randomly assigned to maintain of normothermia or passive cooling. Seven days later, grafts were recovered for bacteriologic study. RESULTS: Colony counts for the grafts removed from the normothermic and hypothermic dogs did not differ significantly. CONCLUSIONS: Mild perioperative hypothermia does not increase proliferation of S epidermidis on aortic vascular grafts.     

Preoperative fluid management contributes to the prevention of intraoperative hypothermia

Intraoperative hypothermia causes several unfavorable events such as surgical site infection and cardiovascular events. Therefore, during anesthesia, temperature is routinely regulated, mainly by using external heating devices. Recently, oral amino acid intake and intravenous amino acid or fructose infusion have been reported to prevent intraoperative hypothermia during general and regional anesthesia. Diet (nutrient)-induced thermogenesis is considered to help prevent intraoperative hypothermia. Since the Enhanced Recovery After Surgery (ERAS) protocol has been introduced, it has been used in perioperative management in many hospitals. Prevention of intraoperative hypothermia is included in this protocol. According to the protocol, anesthesiologists play an important role in both intraoperative and perioperative management. Management of optimal body temperature by preoperative fluid management alone may be difficult. To this end, preoperative fluid management and nutrient management strategies such as preoperative oral fluid intake and carbohydrate loading have the potential to contribute to the prevention of intraoperative hypothermia.