电阻加温垫与充气加温毯预防胸腔镜手术患者低体温效果比较

目的探讨两种加温方式预防胸腔镜手术患者术中低体温的效果。方法将70例胸腔镜手术患者随机分为两组,电阻组(34例)术中采用电阻式碳纤维加温垫加温,充气组(36例)采用充气式加温毯覆盖加温。结果两组各测量时间点患者平均体温均36℃,在麻醉插管、手术开始时、手术开始30 min时电阻组患者体温高于充气组(均P0.01);手术开始1 h后至手术结束,两组体温差异无统计学意义(均P0.05)。结论两种加温方式均能有效预防胸腔镜手术患者术中低体温,其中电阻式碳纤维加温垫维持患者体温更平稳。     

术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响

目的探讨术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响。方法选取择期行机器人腹腔镜膀胱癌根治术患者60例,年龄18～65岁,ASAⅠ～Ⅲ级,随机分为对照组和加温输液组,每组30例。对照组采用常规保温措施(室温24℃以上、患者身体覆盖棉被、预热腹腔冲洗液、术后采用充气式升温系统复温);加温输液组在常规保温措施的基础上术中持续加温输液,温度设置为41℃。观察患者围术期核心体温(鼻咽温)和PT、APTT、TT、Fib、PLT等凝血指标的变化。结果对照组术中体温进行性下降(最低35℃),除了基础值和术后1 h以外的各时间点体温均低于加温输液组,差异有统计学意义(P0.05);加温输液组术中体温与基础值比较也有下降(P0.05),但均在36℃以上。对照组APTT的延长时间大于加温输液组(P0.05)、TT的缩短时间大于加温输液组(P0.05);PT、Fib、PLT组间比较无统计学差异。结论机器人腹腔镜膀胱癌根治术中采用持续加温输液,可维持患者体温正常,避免低体温引起的凝血功能紊乱。     

术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响

［摘要］ 目的 探讨术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响。方法 选取择期行机器人腹腔镜膀胱癌根治术患者60例,年龄18～65岁,ASAⅠ~Ⅲ级,随机分为对照组和加温输液组,每组30例。对照组采用常规保温措施（室温24℃以上、患者身体覆盖棉被、预热腹腔冲洗液、术后采用充气式升温系统复温）;加温输液组在常规保温措施的基础上术中持续加温输液,温度设置为41℃。观察患者围术期核心体温（鼻咽温）和PT、APTT、TT、Fib、PLT等凝血指标的变化。结果 对照组术中体温进行性下降（最低35℃）,除了基础值和术后1 h以外的各时间点体温均低于加温输液组,差异有统计学意义（P<0.05）;加温输液组术中体温与基础值比较也有下降（P<0.05）,但均在36℃以上。对照组APTT的延长时间大于加温输液组（P<0.05）、TT的缩短时间大于加温输液组（P<0.05）;PT、Fib、PLT组间比较无统计学差异。结论 机器人腹腔镜膀胱癌根治术中采用持续加温输液,可维持患者体温正常,避免低体温引起的凝血功能紊乱。     

充气式保温毯用于麻醉复苏室全麻恢复期患者的效果观察

目的评价充气式保温毯在麻醉复苏室预防全麻患者恢复期低体温及寒颤的效果。方法将80例择期全麻手术患者随机分为观察组和对照组各40例。对照组入麻醉恢复室后给予常规太空被保暖;观察组使用充气式保温毯保暖。评价两组患者体温变化及寒颤、苏醒延迟发生率。结果观察组低体温及苏醒延迟率显著低于对照组,入麻醉复苏室30 min、出室时体温显著高于对照组(P0.05,P0.01)。结论应用充气式保温毯能有效降低全麻恢复期患者低体温,促进患者麻醉后苏醒。     

肝移植新肝期体温维护的研究

目的:探讨维护新肝期体温的有效措施.方法:将73例使用充气式保温毯、血液加温仪、40℃温水间断冲洗、有完整体温记录的肝移植患者作为对照组;将肝移植手术中增加使用变温水毯的47例患者做为实验组.观察2组患者进入手术室、无肝期、新肝期的体温变化及最低体温出现时间并进行比较.结果:实验组与对照组除进入手术室、切皮期体温差异无统计学意义外(P>0.05),其余术中不同时间体温差异均有统计学意义(P<0.001).对照组最低体温(34.77±0.93)℃,距门静脉开放后时间为(22.20±33.25)min;实验组最低体温(35.96±0.74)℃,距门静脉开放前时间为(33.40±92.84)min.结论:在新肝期提前升高变温水毯温度比仅使用充气式保温毯、血液加温仪、40℃温水间断冲洗等更有效,术中能有效防止低体温的出现.     

围术期体温保护措施在剖宫产手术中的临床应用研究

目的本研究采用提升手术室室温联合术中液体加温仪的使用对行子宫下段剖宫产术的产妇实施体温保护,以期为产妇围术期体温保护措施的使用提供参考。方法选取本院2014年8月至2016年8月于硬膜外麻醉下首次行子宫下段剖宫产术的足月待产妇共计120例。年龄22~36岁,ASAⅠ~Ⅱ级、无心肺及肝肾功能异常、无体温异常等特殊情况。纳入患者采用随机数字表随机分为两组,体温保护组(T组)和对照组(C组),每组患者各60例。记录两组患者术前30分钟(T_0)、术后10分钟(T_1)、术毕(T_2)、出室后30分钟(T_3)肛温。并记录术中低体温、寒战发生人数及胎儿娩出后1分钟、5分钟新生儿Apgar评分。结果在术中肛温变化方面,两组患者T0时点肛温差异无统计学意义(P0.05)。在T_1、T_2、T_3时点,T组患者肛温显著高于C组患者,差异有统计学意义(P0.05)。在出血量方面,两组患者术中出血量差异无统计学意义(P0.05)。在术中不良反应方面,T组患者低体温、寒战发生率显著低于C组患者,差异有统计学意义(P0.05)。两组患者胎儿娩出后1分钟、5分钟新生儿Apgar评分差异无统计学意义(P0.05)。结论升高手术室室温联合液体加温仪能够对产妇发挥良好的体温保护作用,降低术中低体温及寒战的发生,但对术中出血及新生儿Apgar评分方面的影响尚需更多高质量大样本量随机对照试验加以验证。     

自制复温约束保暖套在全麻开胸术后患者中的应用

目的 寻找一种既能复温保暖又有约束作用的工具.方法 将160例全麻开胸术后患者随机分为对照组和观察组,各80例.对照组采用常规方法复温与约束;观察组在常规复温基础上,采用自制复温约束保暖套行保暖复温约束,复温约束保暖套包括保温、观察与操作和约束三部分,应用时将复温约束保暖套套于手脚后,约束带约束患者脚踝或手腕并系于床挡...     

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。     

输血输液加温仪在库存红细胞悬液输注过程中的应用效果

目的观察输血输液加温仪应用于库存红细胞悬液输注过程的临床效果。方法 80例择期手术的成年患者,男42例,女38例,年龄32~60岁,ASAⅠ或Ⅱ级,随机分为加温组和对照组,每组40例,术中均输注3单位的库存红细胞悬液。加温组库存红细胞悬液通过输血器连接加温仪进行输注,对照组库存红细胞悬液放置于室温中自然复温30min再进行输注。测定加温仪加温前后和对照组复温前后红细胞(RBC)计数、红细胞压积(Hct)及血清K+、Na+、Cl-离子变化;观察输注前、输注后30min的体温变化,输注速度,以及麻醉苏醒期寒战情况。结果两组间及加温/复温前后库存红细胞悬液红细胞计数、HCT、血清K+、Na+、Cl-离子的变化差异均无统计学意义。输注后30min对照组体温降低幅度明显大于加温组(P0.05)。输注过程中加温组均未发生输注速度明显减慢,而对照组有16例(40%)(P0.01)。加温组麻醉苏醒期寒战发生率(5%)明显低于对照组(30%)(P0.01)。所有患者均未发生严重输血不良反应。结论库存红细胞悬液输注过程应用输血输液加温仪临床效果良好,值得临床推广应用。     

充气式保温毯联合输液加温对全麻食管癌手术苏醒和免疫功能的影响

目的探讨充气式保温毯联合输液加温技术对食管癌手术苏醒和免疫功能的影响。方法择期行食管癌根治术患者50例,随机分为温毯+输液输血加温组(W组)和对照组(C组),每组25例。记录麻醉诱导前(T1)、手术开始2h(T2)、手术结束时(T3)、术后2h(T4)的鼻咽温,及麻醉苏醒时间、术后寒战、术后感染及住院时间;采用流式细胞仪检测T1、T3、术后2d(T5)及5d(T6)外周血T淋巴细胞亚群。结果 C组在T2~T4时的鼻咽温较T1时明显降低(P0.05);W组在T2~T4时的鼻咽温明显高于C组(P0.05);C组患者苏醒时间明显延长、术后寒战发生率明显高于W组(P0.05);与T1时比较,两组T3时CD4+淋巴细胞百分率及CD4+/CD8+均明显下降,CD8+淋巴细胞百分率明显升高(P0.05);在T3时,W组CD4+淋巴细胞百分率及CD4+/CD8+明显高于C组,CD8+淋巴细胞百分率明显低于C组(P0.05)。结论在食管癌根治手术中,采用充气式保温毯联合输液加温技术具有保护患者体温、缩短患者苏醒时间、减少术后寒战的发生,同时有利于保护患者的免疫功能。     

Intraoperative patient warming using radiant warming or forced-air warming during long operations

Forced-air warming is the most commonly used and effective method of active warming. A new radiant warming device (Suntouch, Fisher and Paykel) may provide an alternative when the skin surface available for warming is limited. We conducted a randomized controlled trial to compare the efficacy of the Suntouch radiant warmer and forced-air warming. With ethics committee approval 60 surgical patients having procedures anticipated to be more than two hours in duration were recruited. Patients were randomized to either radiant warming or forced-air warming. All intravenous fluids were warmed but prewarming was not used. The final intraoperative core temperatures (degrees C) for the radiant warming and forced-air warming groups were 36.0 +/- 0.5 and 36.4 +/- 0.6 (P=0.002) respectively. No other patient variables were significantly different. The Suntouch is not as effective as the forced air warming for intraoperative warming during long surgical procedures. The device may be useful when forced-air warming is not possible.     

Kidney warming during transplantation

The objective of the present study was to describe kidney temperature variations during transplantation and to identify the factors responsible for kidney warming. Kidney temperature was recorded steadily during transplantation. Kidney weight, body mass index (BMI), second warm ischemia time (t), and kidney temperature at the time of being placed in the recipient were analyzed so that we could evaluate their influence on kidney temperature and on kidney warming during transplantation. Kidney temperature at the time of removal from the container was 1.6 degrees C and 6. 3 degrees C when the kidney was placed in the recipient. Kidney temperature in the recipient depended on kidney temperature after serum washing (P<0.0001), but was independent of kidney preparation time (P=0.94). Then, kidney temperature (T) increased according to the logarithmic curve given in the following equation: T=7.2 ln(t)-0.6. Kidney temperature at the end of anastomosis was 26.7 degrees C. Kidney warming speed was 0.48 degrees/min and was dependent on the length of time of vascular anastomosis (P<0.0001). Kidney weight decreased the kidney warming speed (P=0.02). In conclusion, kidney warming increases slowly during ex vivo preparation. Kidney temperature stays below the damaging ischemic temperature of 18 degrees C. Because of its major impact on kidney warming, it is desirable that vascular anastomosis time be reduced, and, consequently, ex vivo kidney preparation needs to be meticulous.     

Effect of warming on the rectal motile activity: identification of rectal warming reflex

BACKGROUND: The identification in the rectal wall of warm receptors sensitive to warm temperature has not been found in the literature. Therefore, we investigated the hypothesis that rectal warming effects rectal dilation, which seems to indicate the existence of warm receptors. MATERIALS AND METHODS: The rectal wall tone was studied in 24 healthy volunteers (14 men, 10 women, mean age 36.7+/-10.4 years). It was assessed by a barostat system during rectal infusion with normal saline at 30 degrees C, 40 degrees C, 45 degrees C, and 50 degrees C. The test was repeated after rectal anesthetization with lidocaine. RESULTS: The rectal tone on rectal saline infusion at a temperature of 30 degrees C showed no response (P>0.05), whereas at a temperature of 40 degrees C, 45 degrees C, and 50 degrees C, it exhibited a significant decrease (P<0.05, <0.01, <0.001, respectively), which was proportional to the rising degree of temperature. Warm saline infusion into the anesthetized rectum resulted in no significant change in the rectal wall tone. CONCLUSIONS: Rectal infusion with warm saline produced rectal dilation that increased with temperature elevation. This effect is suggested to be mediated through a reflex called "rectal warming reflex: and advances the possibility of the existence of warm receptors in the rectal wall; however, further studies are needed to confirm the issue.     

Perfusion, oxygenation and warming

Perfusion, oxygenation and warming are three elements which have a significant effect on wound healing both with respect to speed and quality of healing. The effects include infection control, increased blood flow and improved quality of granulation tissue. The importance of these elements are outlined and discussed to provide and introduce the importance of oxygen in the healing process.     

Effects of warming on healing

Systemic and local warming may accelerate wound healing and minimise postoperative wound infection, although more research is needed to confirm this. The existing evidence of the benefits of warming therapies is outlined here.     

Comparison of a radiant patient warming device with forced air warming during laparoscopic cholecystectomy

The importance of maintaining a patient's core body temperature during anaesthesia to reduce the incidence of postoperative complications has been well documented. The standard practice of this institution is the use of a forced air device for intraoperative warming. The purpose of this study was to compare this standard with an alternative warming device using a radiant heat source which only heated the face. This prospective, randomized controlled trial compared the efficacy of two methods of intraoperative warming: the BairHugger (Augustine Medical, U.S.A.) forced air device and the SunTouch (Fisher & Paykel Healthcare, N.Z.) radiant warmer during laparoscopic cholecystectomy in 42 female patients. Oesophageal core temperatures were recorded automatically on to computer during operations using standardised anaesthesia, intravenous infusions and draping. The study failed to show any statistical or clinical difference between the two patient groups in terms of mean core temperature both intraoperatively (P = 0.42) and in the recovery period (P = 0.54). Mean start to end core temperature differences were marginally lower in the radiant group (0.08 degree C) but not statistically or clinically significantly different. Given some of the drawbacks with forced air systems, such as the expense of the single use blanket, this new radiant warming device offers an alternative method of active warming with advantages in terms of cost and possible application to a wide variety of surgical procedures.