充气加温法对围手术期轻度低体温的预防作用

目的:探讨充气加温法预防术中全麻病人低体温的临床应用价值。方法:择期于全身麻醉下行结肠或直肠手术,术程大于2小时,ASA Ⅰ-Ⅱ级的病人40例,随机分为A、B两组,A组采用常规温度处理即在非手术部位覆盖手术单及一层棉被,B组采用常规的温度处理+充气加温。术中监测核心体温,术后随访寒战、温度舒适度情况。结果:两组病人术毕核心体温分别为35.2+0.2℃,36.5±0.18℃(P<0.05),A组病人温度舒适度评分为20±5 mm,而B组为45±10 mm,两组比较具有统计学差异(P<0.05)。A组病人共有12例发生寒战,而B组仅有2例发生轻度寒战,两组比较具有统计学差异(P<0.05)。结论:常规的温度处理不能使病人在围手术期保持正常体温,充气加温可以有效地使病人在围手术期保持正常体温。围手术期轻度低体温可以明显增加麻醉后寒战的发生率。     

The Effect of Active Warming on Postoperative Hypothermia on Body Temperature and Thermal Comfort: A Randomized Controlled Trial

PurposeThe purpose of this study was to determine the effect of active warming method in temperature control and thermal comfort in hypothermia after surgery.DesignA randomized controlled trial.MethodsThe study sample consisted of 64 male and female postanesthesia care unit and intensive care unit neurosurgery postoperative inpatients. The experimental group was warmed using the active warming method, and the control group's routine care was continued via a cotton blanket. Patients were warmed until their tympanic body temperature reached 37°C.FindingsThe time needed to adequately warm patients was approximately twice as short in those who received active warming as compared with the control group. The perception of thermal comfort was significantly higher in the first hour in patients who received the active warming method (P < .05).ConclusionsThe active warming method resulted in a shorter time to warming in hypothermia after surgery and an increase in the perception of thermal comfort and body temperature.     

A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia

Aims. To retrieve and critique recent randomised trials of cutaneous warming systems used to prevent hypothermia in surgical patients during the intraoperative period and to identify gaps in current evidence and make recommendations for future trials. Background. Hypothermia affects up to 70% of anaesthetised surgical patients and is associated with several significant negative health outcomes. Design. Systematic review using integrative methods. Methods. We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline databases (January 2000–April 2007) for recent reports on randomised controlled trials of cutaneous warming systems used with elective patients during the intraoperative period. Inclusion criteria. We included randomised control trials examining the effects of cutaneous warming systems used intraoperatively on patients aged 18 years or older undergoing non‐emergency surgery. Studies published in English, Spanish or Portuguese with a comparison group that consisted of either usual care or active cutaneous warming systems without prewarming were reviewed. Results. Of 193 papers initially identified, 14 studies met the inclusion criteria. There was moderate evidence to indicate that carbon‐fibre blankets and forced‐air warming systems are equally effective and that circulating‐water garments are most effective for maintaining normothermia during the intraoperative period. Few trials reported costs. Conclusions. Carbon‐fibre blankets and forced‐air warming systems are effective and circulating‐water garments may be preferable. Future research should measure the direct and indirect costs associated with competing systems. Relevance to clinical practice. Nurses can use this review to inform their selection of warming interventions in perioperative nursing practice. They can also assess other factors such as nursing workload, staff training and equipment maintenance, which should be incorporated into future research.     

Effect of the ASPAN Guideline on Perioperative Hypothermia Among Patients With Upper Extremity Surgery Under General Anesthesia: A Randomized Controlled Trial

PurposeTo evaluate the effect of using the evidence-based hypothermia guideline developed by the American Society of PeriAnesthesia Nurses on body temperature, shivering, thermal discomfort and comfort, and incidence of hypothermia.DesignRandomized controlled trial with 54 patients undergoing upper arm surgery with general anesthesia in the Republic of Korea.MethodsParticipants in the experimental group received a head turban, sleeping socks, a heated blanket, a Bair Hugger for forced-air warming, and a Mega Acer kit (ACE Medical Co, Seoul, Korea) for warming intravenous fluid. Participants in the control group received a typical hospital cotton blanket.FindingsBody temperature, shivering, thermal discomfort, and thermal comfort showed significant improvements in the experimental group compared with the control group.ConclusionsThe American Society of PeriAnesthesia Nurses guideline is applicable for preventing hypothermia under general anesthesia, which, in turn, aids in patient recovery through the suppression of various hypothermia-related complications.     

Glycemic Control: A Literature Review with Implications for Perioperative Nursing Practice

Surgical patients have an increased risk for hyperglycemia and its subsequent complications, such as increased risk of infection, morbidity and mortality, and length of stay.Interventional studies indicate that tight glycemic control with intensive insulin therapy improves outcomes. More recent randomized controlled trials, however, provide conflicting results, indicating that hypoglycemia and death may result from tight glycemic control. This calls into question the safety and efficacy of tight glycemic control.Perioperative nurses must be prepared to implement measures to control hyperglycemia for patients with and without diabetes throughout the perioperative process. Perioperative nurses should participate in multidisciplinary efforts to develop evidenced-based glycemic control protocols. AORN J 90 (November 2009) 714-726. © AORN, Inc, 2009.     

Blood pH is a Useful Indicator for Initiation of Therapeutic Hypothermia in the Early Phase of Resuscitation after Comatose Cardiac Arrest: A Retrospective Study

Background

Therapeutic hypothermia (TH) is one of the key treatments after cardiac arrest (CA). Selection of post-CA patients for TH remains problematic, as there are no clinically validated tools to determine who might benefit from the therapy.

Objective

The aim of this study was to investigate retrospectively whether laboratory findings or other patient data obtained during the early phase of hospital admission could be correlated with neurological outcome after TH in comatose survivors of CA.

Methods

Medical charts of witnessed CA patients admitted between June 2003 and July 2009 who were treated with TH were reviewed retrospectively. The subjects were grouped based on their cerebral performance category (CPC) 6 months after CA, as either good recovery (GR) for CPC 1–2 or non-good recovery (non-GR) for CPC 3–5. The following well-known determinants of outcome obtained during the early phase of hospital admission were evaluated: age, gender, body mass index, cardiac origin, presence of ventricular fibrillation (VF), time from collapse to cardiopulmonary resuscitation, time from collapse to return of spontaneous circulation, body temperature, arterial blood gases, and blood test results.

Results

We analyzed a total of 50 (25 GR and 25 non-GR) patients. Multivariate logistic analysis showed that initial heart rhythm and pH levels were significantly higher in the GR group than in the non-GR group (ventricular tachycardia/VF rate: p = 0.055, 95% confidence interval [CI] 0.768–84.272, odds ratio [OR] 8.047; pH: 7.155 ± 0.139 vs. 6.895 ± 0.100, respectively, p < 0.001, 95% CI 1.838–25.827; OR 6.89).

Conclusion

These results imply that in addition to initial heart rhythm, pH level may be a good candidate for neurological outcome predictor even though previous research has found no correlation between initial pH value and neurological outcome.     

无线体温传感器监测日间手术术中核心体温的可行性:前瞻性诊断试验

目的观察日间手术中采用无线体温传感器持续监测核心体温的有效性和可行性。方法前瞻性收集从2017年10月25日至2017年12月8日,在四川大学华西医院接受日间手术患者术中体温监测的数据,每组数据包括食管温度、直肠温度和无线体温传感器监测的腋窝温度。以食管温度为标准,计算腋窝温度及直肠温度与其差值,并分析二者与食管温度的一致性。结果共113例符合纳入和排除标准的患者入选本研究,采集到1451组体温监测数据。以食管温度为标准,腋窝温度较食管温度低(0. 06±0. 26)℃,而直肠温度较食管温度高(0. 39±0. 23)℃。相关分析显示腋窝温度(r=0. 9331)较直肠温度(r=0. 8431)更接近食管温度。腋窝温度在食管温度±0. 5℃以内的比例为94. 97%,而直肠温度为78. 91%。结论无线体温传感器用于成人日间手术术中持续核心体温监测是有效可行的。     

Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study

Objectives:  Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post–cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.
Methods:  After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33–34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ≥85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.
Results:  Clinicians attempted HT on 23 post–cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8–7.2) hours. Complication rates were low.
Conclusions:  Using a standardized order set, clinicians can achieve HT target temperature in routine practice.     

Long-Term Pain and Recovery After Major Pediatric Surgery: A Qualitative Study With Teens,Parents, and Perioperative Care Providers

Research developing targeted treatment focused on coping with children's long-term pain after surgery is needed because of the high prevalence of chronic pain after surgery. This qualitative study aimed to: 1) understand the child's and family's experiences of pain over the course of their surgical experience, and 2) gather stakeholder input regarding potential barriers and facilitators of perioperative intervention delivery. Fifteen children ages 10 to 18 years who underwent recent major surgery, their primary caregivers, and 17 perioperative health care providers were interviewed. Interviews were coded using semantic thematic analysis. The perioperative period presented emotional challenges for families. Families felt unprepared for surgery and pain. Recovery and regaining physical functioning at home was challenging. Families struggled to return to valued activities. Families reported interest in a perioperative psychosocial intervention. Providers endorsed that families would benefit from enhanced coping skills. They emphasized that families would benefit from more detailed preparatory information. Providers suggested that flexible intervention delivery at home would be ideal. Research developing interventions addressing pain and anxiety in children undergoing major surgery is critically needed. The findings of the present study can inform intervention development with the aim of improving short- as well as long-term recovery in children undergoing major surgery.

Barriers to Pediatric Pain Management in Children Undergoing Surgery: A Survey of Health Care Providers

The appropriate pain management in neonates and children is lacking. Factors that prevent the execution of proper pain relief vary from center to center. We studied the factors responsible for it in a surgical unit. We conducted a survey at a tertiary-level institute among the resident doctors and nursing staff by means of an informal questionnaire analyzing their basic knowledge. The questions pertained mainly to pain assessment, analgesic usage, role of opioids, and formal training, and the responses so obtained were analyzed under these four headings. Seventy-three percent (22/30) of the residents and 74% (26/35) of the nursing staff knew about pain assessment scoring system in pediatric patients. However, assessment of pain in emergency cases was always done by only 6.6% of the residents. Effect of analgesia on severity of pain was never recorded by 33% (10/30) of the residents. Eighty-six percent (26/30) of the residents and 91% (32/35) of the nursing staff had adequate knowledge about analgesic dosage and interval for routine use. Ten of the 30 (33%) residents believed that analgesic administration in an acute abdomen, before definitive diagnosis, will always mask the symptoms. During a minor procedure, 56% (17/30) of the residents always used analgesia. Only 3.3% (1/30) of residents and 2.8% (1/35) of the nursing staff had received a structured training for pain management. Although, 93% (28/30) of the residents claimed to know about the safety of use of opioids, only 46% (14/30) used them routinely as analgesics. Pain management in surgical neonates and children is often ignored. Lack of formal training, inadequate knowledge, and standard protocols are the barriers in our setup, which may in turn be due to overwhelming attention given to the surgical condition.