充气升温毯维持围手术期核心体温有效性的系统评价

目的 系统评价充气升温毯维持患者围手术期核心体温的有效性,为围手术期选择合适的保温方法提供临床依据.方法 计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、CBM、CNKI数据库,全面收集不同保温方法维持围手术期核心体温有效性的随机对照试验(RCT),检索时限均为2000～2012年,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析.结果 纳入11个RCT,共577例患者.Meta分析结果显示:在维持围手术期核心体温方面,充气升温毯加温组分别优于电热毯/垫组SMD=-0.40,95％CI (-0.73,-0.06)]、循环水温毯组SMD=-1.10,95％CI(-1.55,-0.66)]和红外线辐射加温组SMD=-0.69,95％CI(-1.06,-0.32)];在围手术期低体温发生率方面,充气升温毯组低于电热毯/垫加温组RR=1.76,95％CI(1.15,2.69)],而与红外线辐射加温组相当RR=l.37,95％CI(0.83,2.27)];在围手术期寒战发生率方面,充气升温毯加温组与电热毯/垫组RR=0.75,95％CI (0.18,3.21)]和红外线辐射加温组相当RR=0.8,95％CI(0.19,3.36)].结论 充气升温毯与电热毯/垫、红外线辐射、循环水温毯相比,能够更好地维持围手术期患者核心体温,患者低体温发生率更低.受纳入研究数量和质量所限,上述结论尚需开展更多大样本高质量RCT加以验证.

Effectiveness of Forced Air Warming for the Maintenance of Perioperative Core Temperature：A Meta-Analysis

Objective To systematically review the effectiveness of forced air warming for the maintenance of perioperative core temperature,so as to provide clinical evidence for an appropriate warming plan during the perioperative period.Methods We electronically searched PubMed,The Cochrane Library,EMbase,Web of Science,CBM and CNKI from 2000 to 2012,so as to comprehensively collect randomized controlled trials（RCTs） about the effectiveness of different warming methods for the maintenance of perioperative core temperature（including forced air warming,resistive-heating blanket/electric heating pad,circulating water mattress,and infrared ray radiant heating system） for maintenance of perioperative core temperature.References of the included studies were also retrieved.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data and assessed the quality of the included studies.Then,meta-analysis was performed using RevMan 5.1 software.Results Eleven RCTs involving 577 patients were included.The results of meta-analysis indicated that,in the maintenance of core temperature during the perioperative period,forced air warming was superior to resistive-heating blanket/electric heating pad（SMD=-0.40,95%CI -0.73 to -0.06）,circulating water mattress（SMD=-1.10,95%CI -1.55 to -0.66）,and infrared ray radiant heating system（SMD=-0.69,95%CI -1.06 to -0.32）.In the incidence of hypothermia during the perioperative period,the group of forced air warming was lower than the group of blanket/electric heating pad（RR=1.76,95%CI 1.15 to 2.69）,but it was the same as the group of infrared ray radiant heating system（RR=1.37,95%CI 0.83 to 2.27）.In the incidence of shivering during the perioperative period,the group of forced air warming was the same as the group of blanket/electric heating pad（RR=0.75,95%CI 0.18 to 3.21） and the group of infrared ray radiant heating system（RR=0.8,95%CI 0.19 to 3.36）.Conclusion Compared with resistive-heating blanket/electric heating pad,circulating water mattress,and infrared ray radiant heating system,forced air warming maintains patients＇ core temperature better during the perioperative period,with a lower incidences of hypothermia.Due to the limited quantity and quality of the included studies,more high quality RCTs with large sample size are needed to verify the above conclusion.