右美托咪啶辅助改善肺癌根治术麻醉后寒战的临床应用

目的探讨右美托咪啶辅助改善肺癌根治术麻醉后寒战的临床疗效。方法该研究于2010年2月—2012年2月对收治的68例需要进行肺癌根治手术的患者作为研究对象进行了右美托咪啶辅助改善肺癌根治术麻醉后寒战的临床效果研究,并与采用生理盐水的对照组进行临床对比研究。结果两组患者的各一般资料、手术时间、术中输液量及拔管时间比较差异无统计学意义;而研究组的七氟醚用量和曲马多使用率均较对照组明显下降,而阿托品使用率则明显上升,且差异有统计学意义(χ2或t=3.02、12.35、13.47,P<0.05)。研究组患者的术后寒战发生率明显低于对照组,且差异有统计学意义(χ2=14.23,P<0.05)。结论在肺癌根治术后使用右美托咪啶辅助治疗可以有效降低患者麻醉后寒战的发生率。     

硫酸镁预防前列腺电切术患者术中寒战发生的临床观察

目的：观察静脉注射硫酸镁预防腰麻下行经尿道前列腺电切（TURP）患者术中寒战发生的效果。方法选择70例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级腰麻下行TURP术的患者，随机分为2组：硫酸镁组和生理盐水组，各35例。硫酸镁组于腰麻后20 min内缓慢静脉注射25%MgSO 4注射液80mg/kg，随后静脉泵注MgSO42g/h直至手术结束；生理盐水组则在相同时间内给予相同剂量的0.9%生理盐水。结果硫酸镁组术中有5例发生寒战反应，发生率为14.3%,生理盐水组有23例发生寒战反应，发生率为65.7%，2组寒战反应发生率比较差异有统计学意义（P<0.05）；硫酸镁组均出现低体温，生理盐水组有30例出现低体温，2组差异有统计学意义（P<0.05）；硫酸镁组术后血镁浓度（2.47±0.67）高于生理盐水组（0.89±0.20）（P<0.05）；2组患者术后6h检查膝跳反射差异无统计学意义。结论静脉注射硫酸镁可安全、有效地防治腰麻下TURP术患者术中寒战的发生。     

六西格玛管理法下应用艾灸预防手术室全麻患者低体温及寒战的作用

目的探讨六西格玛管理法下应用艾灸预防手术室全麻患者低体温和寒战的作用。方法选取全麻手术患者80例,分为两组各40例。对照组采用常规护理干预,观察组在对照组的基础上给予六西格玛管理法下艾灸。比较两组术前(T1)、进入麻醉恢复室(T2)、复温30 min(T3)、出麻醉恢复室时(T4)的核心体温,以及寒战、躁动和低体温发生率。结果两组T1和T2时的核心体温无统计学差异(P>0.05);T3和T4时,观察组的核心体温显著高于对照组(P<0.05)。观察组的寒战、躁动和低体温发生率均显著低于对照组(P<0.05)。结论六西格玛管理法下应用艾灸可有效预防手术室全麻患者低体温和寒战的发生。     

Alteration of shivering threshold in cold-and warm-adapted guinea pigs following intrahypothalamic injections of noradrenaline and of an adrenergic alpha-receptor blocking agent

Summary The role of adrenergic receptors in the central thermoregulatory pathways controlling the shivering activity has been studied in groups of cold-adapted (CA), warm-adapted (WA) and newborn (NB) guinea pigs, which show quantitative differences in shivering threshold. In the CA and NB animals, which normally start to shiver at lower mean body temperature levels than the WA controls, microinjection of noradrenaline (1 g in 1 l) into the noradrenaline-sensitive area of the anterior hypothalamus elicited shivering at higher body temperatures at which normally only WA animals start to shiver. Similar injections into the hypothalamus of WA animals did not induce any further shift of the shivering threshold. Microinjections of the alpha-receptor blocking agent phentolamine into the same brain area shifted the shivering threshold in all groups of animals to lower body temperatures, the shift being proportional to the injected dose of phentolamine. The CA and NB animals required higher doses of phentolamine to produce a change in shivering threshold. It is concluded that adrenergic alpha receptors are involved in the central thermoregulatory mechanisms which adjust the thresholds for the thermoregulatory reactions.This study was supported by the Deutsche Forschungsgemeinschaft (SFB 122, Projekt B 1).     

降低剖宫产产妇术中低体温发生率的实践与成效

目的 为降低剖宫产产妇术中低体温的发生率,应用品管圈活动改进护理质量,观察其成效.方法 选择2016年3-4月行剖宫产手术产妇55例为活动前对照组,按照剖宫产手术护理常规进行护理.选择2016年6-7月份组织实施品管圈活动并在同一家医院剖宫产手术产妇55例为活动后观察组.观察活动前和活动后剖宫产产妇麻醉前、麻醉后、胎儿娩出后及出室前的体温,比较活动前后剖宫产产妇术中低体温的发生率.结果 活动前与活动后产妇的年龄、手术时间和基础体温上的差异无统计学意义(P>0.05).活动前对照组产妇低体温发生率为21.8%,活动后观察组低体温发生率为7.3%,差异有统计学意义(χ2 =4.681,P=0.031).结论 运用品管圈活动能有效降低剖宫产产妇术中低体温的发生率.     

不同温度输液对妇科术中病人体温及热量的影响

目的 :观察不同温度下输液对手术病人体温及热量的影响。方法 :将 5 6例子宫全切病人随机分为两组 ,温液体组和室温液体组。分别于麻醉前及麻醉后 15、30、6 0、12 0min和术终记录肛温、热量和寒战反应 ,并进行统计学比较。结果 :硬膜外阻滞麻醉后 30min两组病人肛温升高 0 .5℃后渐降 ,温液体组病人较室温组肛温降低幅度小 ,无热量丢失、寒战反应发生率低 (P <0 .0 1)。寒战病人肛温较非寒战病人者低 (P <0 .0 1) ,热量丢失多。结论 :预热静脉液体不仅可避免因输注液体温度低而引起的肢体发凉、发麻、胀疼、寒战 ,还可以防止术中体温降低和热量丢失。     

Dexmedetomidine for the prevention of shivering during spinal anesthesia

PURPOSE:

The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia.

METHODS:

Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection.

RESULTS:

Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207).

CONCLUSION:

Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.     

Association of the Bedside Shivering Assessment Scale and derived EMG power during therapeutic hypothermia in survivors of cardiac arrest

Introduction

Shivering during therapeutic hypothermia (TH) after cardiac arrest (CA) is common, but the optimal means of detection and appropriate threshold for treatment are not established. In an effort to develop a quantitative, continuous tool to measure shivering, we hypothesized that continuous derived electromyography (dEMG) power detected by the Aspect A2000 or VISTA monitor would correlate with the intermittent Bedside Shivering Assessment Scale (BSAS) performed by nurses.

Methods

Among 38 patients treated with TH after CA, 853 hourly BSAS measurements were compared to dEMG power measured every minute by a frontal surface electrode. Patients received intermittent vecuronium by protocol to treat clinically recognized shivering (BSAS > 0). Mean dEMG power in decibels (dB) was determined for the hour preceding each BSAS measurement. dEMG and BSAS were compared using ANOVA.

Results

The median dEMG power for a BSAS score of 0 (no shivering) was 27 dB (IQR 26-31 dB), BSAS 1 was 30.5 dB (IQR 28-35 dB), BSAS 2 was 34 dB (IQR 30-38 dB), and BSAS 3 was 34.5 dB (IQR 32-44.25). The dEMG for BSAS ≥ 1 (shivering) was statistically different from BSAS 0 (p < 0.0001). dEMG and BSAS correlated moderately (r = 0.66, p < 0.001).

Conclusion

dEMG power measured from the forehead with the Aspect A2000 or VISTA monitor during therapeutic hypothermia correlated with the Bedside Shivering Assessment Scale. Given its continuous trending of dEMG power, the A2000 or VISTA may be a useful research and clinical tool for objectively monitoring shivering.     

东莨菪碱与曲马多对术中寒战影响的临床观察

目的观察东莨菪碱与曲马多对寒战后相关反应的影响。方法选择腰硬联合麻醉下发生寒战的60例病例,随机分为曲马多(T)组,东莨菪碱(S)组和生理盐水(C)组,分别给予曲马多1.0mg/kg,东莨菪碱0.01mg/kg及生理盐水,均用生理盐水稀释成5毫升后15秒缓慢静脉推注。分别记录入室时,麻醉5分钟后,寒战3分钟后,给药后1、3、5、10、20、30分钟的SBP、DBP、MAP、HR、SPO2、寒战分级、镇静分级,恶心呕吐分级及患者自身感受,并计算RPP(心肌氧耗指数=心率×收缩压)。结果 S组心率高于另外两组;三组血压无差异;寒战评分方面,T组与C组相比有显著差异(P<0.05),S组与C组相比有显著差异(P<0.05),T组与S组相比也具有显著差异(P<0.05);T组使RPP降低的程度明显高于S组;T组不良反应少于S组。结论 1mg/kg曲马多和0.01mg/kg东莨菪碱稀释成5毫升后15秒缓慢静推均可有效治疗寒战,而且前者具有起效快,疗效明显,复发率低,不良反应少,明显降低心肌氧耗的优点。