复合保温管理对肝癌患者术中低体温的预防效果分析

目的 探讨复合保温管理对肝癌患者术中低体温的预防效果.方法 根据干预方法的不同将108例接受手术治疗的肝癌患者分为观察组(n=60)和对照组(n=48),观察组患者行复合保温管理,对照组患者行常规保温干预.比较两组患者进入手术室时、停用麻醉药物时、麻醉后每隔30 min时及手术结束时的体温,比较两组患者的低体温发生情况...     

对胸外科手术患者浅低温综合护理干预的效果评价

目的降低胸外科手术患者浅低温的发生率,提高围术期的护理质量。方法将普通胸外科手术患者各155例分为两组,比较手术患者浅低温综合护理干预的临床效果。对照组为常规护理;实验组采取如下干预方法：恒定室温、冲洗体腔盐水加温、铺垫38℃水循环变温毯、手术裸露部位用不同形状棉毯保护、热空气暖风装置保护体温,并制定手术患者浅低温预防的护理常规、流程、制度。评价指标为：患者年龄、手术时间、切口感染、肺部感染和浅低温发生率。结果两组浅低温发生率分别为57．41％、18．06％;切口感染率分别为8．38％、0．64％;肺部感染率分别为29．67％、5．8％。3项评价指标均有显著性差异（P〈0．01）。结论胸外科围术期患者的体温保护应成为手术室的护理常规,体温保护是提高围术期患者的护理质量、降低术后并发症的重要影响因素,应成为胸外科手术护理不可忽视的重要护理内容。     

低温治疗对药物的药代动力学和药效学影响的系统性评价

目的 系统评价低温治疗对人体药代动力学和药效学的影响.方法 检索PubMed、EmBase和Cocrane Library从数据库建库至2020-03-17,有关低温治疗对于人体药代动力学及药效学的比较研究,限制语言为英语.将纳入文献中药代动力学及药效学参数用相对差异表示,进行系统性评价.结果 共纳入27项研究.在低温...     

The effects of hypoxia and CO2 on the sleep-waking pattern of the potoroo (Potorous tridactylus apicalis)

Four male potoroos (Potorous tridactylus apicalis) breathed 21% and 7% O₂ with and without the addition of 5% CO₂. The effects of these gas mixtures on the potoroo's sleeping-waking pattern (SWP) were studied. The SWP while breathing 21% O₂/5%CO₂ was unchanged when compared with that of breathing ambient air (21% O₂). While breathing 7% O₂, the SWP was severely disrupted: total sleep time (TST) and slow wave sleep (SWS) increased markedly. Brain temperature fell substantially. Paradoxical sleep (PS) was almost abolished and wakefulness (W) decreased. The addition of 5% CO₂ to the O₂ deficient gas mixture, i.e., 7% O₂/5% CO₂, restored the SWP to that obtained while breathing ambient air. It is concluded that CO₂ neutralizes the disruptive effect which hypoxia has on the potoroo's SWP. It is hypothesized that this constitutes a homeostatic mechanism for stabilizing the SWP and is carried over from pouch life.     

Major childhood tumor resection using normovolemic hemodilution anesthesia and hetastarch

Acute normovolemic hemodilution is a safe technique for minimizing operative blood loss during major tumor resection in children. Based on our experience using hemodilution anesthesia in 14 successful extensive tumor resections, we conclude the following: (1) this is an effective means of reducing use of bank blood and thus avoiding the risks of multiple transfusions; (2) it facilitates surgical dissection due to increased visibility with dilute blood, and decreased bleeding due to controlled hypotension; (3) this technique is acceptable for Jehovah's Witnesses; (4) hetastarch is an effective, inexpensive colloid hemodiluent which minimized perioperative edema compared to crystalloid hemodilution.     

Atención integral del neonato con encefalopatía hipóxico-isquémica en España

IntroductionThere is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement.MethodA cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan.ResultsMost centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres.ConclusionsThe care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up.     

The utility of traditional prehospital interventions in maintaining thermostasis

Objective. Hypothermia can have a negative effect on the metabolic and hemostatic functions of patients with traumatic injuries. Multiple methods of rewarming are currently used in the prehospital arena, but little objective evidence for their effectiveness in this setting exists. The purpose of this study was to assess the relative effectiveness of traditional prehospital measures in maintaining thermostasis in trauma patients. Methods. Participating helicopter and ground ambulance ALS units were prospectively randomized to provide either routine care only (passive or no warming) or routine care (passive warming) in conjunction with active warming (either reflective blankets, hot pack rewarming, or warmed IV fluids). A total of 174 trauma code patients, aged >14 years, who met inclusion criteria were prospectively enrolled by prehospital providers. Patients who received a non-assigned intervention or who had incomplete temperature data were dropped from the analysis. A total of 134 patients were included in the final analysis. Results. Patients who received hot pack rewarming showed a mean increase in body temperature during transport (+1.36°F/0.74°C), while all other groups (no intervention, passive rewarming, reflective blankets, warmed IV fluids, warmed IV fluid plus reflective blanket) showed a mean decrease in temperature during transport [-0.34 to -0.61°F (-0.2 to -0.4°C); p < 0.01]. In addition, the hot pack group was consistent, with every patient who received hot pack warming showing an increase in body temperature during transport, while in all other groups there were patients who had both increases and decreases in temperature. The intervention groups did not differ significantly on exposure to precipitation, transport unit temperature, total prehospital time, initial vital signs, amount of fluid administered, Injury Severity Score, or Glasgow Coma Score. Conclusions. Most traditional methods of maintaining trauma patient temperature during prehospital transport appear to be inadequate. Aggressive use of hot packs, a simple, inexpensive intervention to maintain thermostasis, deserves further study as a potential basic intervention for trauma patients.