Nesher N, Wolf T, Kushnir I, David M, Bolotin G, Sharony R, Pizov R, Uretzky G
Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ann Thorac Surg. 2001 Sep;72(3):S1069-76. doi: 10.1016/s0003-4975(01)02943-5.
Myocardial ischemia, arrhythmias, and coagulopathies are associated with postoperative hypothermia. This study assessed the efficacy of a novel thermoregulation system in alleviating these events during coronary artery bypass graft (CABG) surgery.
Elective CABG surgery patients were randomized into either Allon thermoregulation (AT, n = 40) or routine thermal care (RTC, n = 20) groups in whom the maintenance of normothermia during the nonbypass phases of the operation was compared. The AT used patients' rectal temperature as reference data to monitor the maintenance of the water temperature circulating at 37 degrees C in a garment. Rectal temperature, patient hemodynamics, and cardiac-specific troponin I (cTnI) levels were assessed at the induction of anesthesia, 30 minutes into surgery, at discontinuation of bypass, end of surgery, and 2 hours postoperatively.
Body temperature was higher in the AT group compared to the RTC group at all five time points. Cardiac index (CI) (L/min) was higher in the AT group, 2.5 +/- 0.5, 2.6 +/- 0.5*, 3.2 +/- 0.6*, 3.3 +/- 0.5*, 3.1 +/- 0.7 at the respective time points, compared to the RTC group, 2.3 +/- 0.6, 2.1 +/- 0.2, 2.6 +/- 0.7, 2.7 +/- 0.7, 2.7 +/- 0.7 (*p < 0.05). Systemic vascular resistance (SVR) (dyne x s)/cm5) was consistently lower in the AT patients. Enzyme levels were elevated in both groups but were less so in the AT patients.
The AT system can efficiently maintain normothermia. The beneficial effects are expressed by reduced SVR, elevated CI, and lower levels of cTnI, which may show a possible attenuation of myocardial injury.
心肌缺血、心律失常和凝血功能障碍与术后体温过低有关。本研究评估了一种新型体温调节系统在冠状动脉旁路移植术（CABG）手术期间缓解这些情况的疗效。
择期CABG手术患者被随机分为Allon体温调节组（AT，n = 40）或常规体温护理组（RTC，n = 20），比较两组在手术非体外循环阶段维持正常体温的情况。AT组以患者直肠温度作为参考数据，监测在一件衣服中循环的水温维持在37摄氏度的情况。在麻醉诱导时、手术30分钟时、体外循环停止时、手术结束时和术后2小时评估直肠温度、患者血流动力学和心脏特异性肌钙蛋白I（cTnI）水平。
在所有五个时间点，AT组的体温均高于RTC组。与RTC组相比，AT组在各个时间点的心脏指数（CI）（L/分钟）更高，分别为2.5±0.5、2.6±0.5*、3.2±0.6*、3.3±0.5*、3.1±0.7，而RTC组分别为2.3±0.6、2.1±0.2、2.6±0.7、2.7±0.7、2.7±0.7（*p < 0.05）。AT组患者的全身血管阻力（SVR）（达因×秒）/厘米5）持续较低。两组的酶水平均升高，但AT组患者升高程度较小。
AT系统可有效维持正常体温。其有益效果表现为SVR降低、CI升高和cTnI水平降低，这可能表明心肌损伤可能有所减轻。
