Hasankhani H, Mohammadi E, Moazzami F, Mokhtari M, Naghgizadh M M
Isfahan medical university, Isfahan, Iran.
Can Oper Room Nurs J. 2007 Mar;25(1):20-4, 26-7.
Perioperative hypothermia is physiologically stressful because it elevates blood pressure, heart rate and plasma catecholamine concentration that may increase the risk of cardiac complications, bleeding, wound infection, and post-anaesthesia care unit stay. This study was designed to evaluate the effects of warming intravenous fluids on perioperative hemodynamic situation, post-operative shivering and recovery in orthopaedic surgery patients.
Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in sixty patients undergoing orthopaedic surgery that were randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using a dry IV fluid warmer.
The core and skin temperatures of the hypothermia and normothermia groups decreased significantly between the induction of anesthesia and the end of surgery, but the drop was greater in the hypothermia group (P < 0.005). Postoperative mean arterial blood pressure (non-invasive) increased significantly more in the hypothermia group versus normothermia group (p < 0.005). Shivering was observed in 21 of 30 in the hypothermia group and 11 of 30 in the normothermia group (p < 0.005) and recovery time was significantly lower in the normothermia group (36 +/- 5 vs. 26 +/- 3 min, p < 0.005).
Intraoperative IV fluid warming reduces perioperative changes to the hemodynamic situation, post-operative shivering, and recovery time.
围手术期体温过低会产生生理应激反应，因为它会升高血压、心率和血浆儿茶酚胺浓度，这可能会增加心脏并发症、出血、伤口感染及在麻醉后护理病房停留时间的风险。本研究旨在评估静脉输液加温对骨科手术患者围手术期血流动力学状况、术后寒战及恢复情况的影响。
对60例行骨科手术的患者测量围手术期脉搏率、血压、术中食管及皮肤温度，根据术中静脉输液管理将患者随机分为两组。30例患者（体温过低组）输注的所有静脉液体均为室温。另外30例患者（正常体温组）所有静脉液体均使用干式静脉液体加温器进行加温。
体温过低组和正常体温组的核心温度和皮肤温度在麻醉诱导至手术结束期间均显著下降，但体温过低组下降幅度更大（P < 0.005）。与正常体温组相比，体温过低组术后平均动脉血压（无创）升高更为显著（p < 0.005）。体温过低组30例中有21例出现寒战，正常体温组30例中有11例出现寒战（p < 0.005），正常体温组恢复时间显著更短（36 ± 5 分钟 vs. 26 ± 3 分钟，p < 0.005）。
术中静脉输液加温可减少围手术期血流动力学状况的变化、术后寒战及恢复时间。
