Putzu Marta, Casati Andrea, Berti Marco, Pagliarini Giovanni, Fanelli Guido
Dept of Anesthesiology, E. Franchini Hospital, AUSL Reggio Emilia, Montecchio (RE), Italy.
Acta Biomed. 2007 Dec;78(3):163-9.
Perioperative hypothermia is a frequent occurrence and can lead to several complications, which adversely affect the patient's outcome, expecially in high risk patient. Nonetheless, central temperature is not frequently monitored in the clinical routine. The aim of this work is to make the point on complications, monitoring techniques, prevention and treatment of mild perioperative hypothermia.
We reviewed literature on cardiovascular, haemorragic, infectious, and other clinical consequences of mild intraoperative hypothermia, epidemiology and techniques, of temperature monitoring and efficacy of different approaches for the prevention and treatment of mild hypothermia.
Cardiovascular, haemorragic and infectious complications are significantly more frequent in hypothermic than in normothermic patients. Elderly and high risk patients are more prone to develop perioperative hypotherma, and are more liable to hypothermia-related complications. The ideal monitoring site has to be chosen considering both the patients characteristics and surgical procedure. Once identified, hypothermia has to be treated and the most effective systems are represented by active forced-air skin warming system. Active prewarming during the preoperative period has been also demonstrated to be efficient in reducing the development of intraoperative hypothermia. Humidification and warming of inspired gases, and warming of intravenous fluids are useful techniques when used in a multimodal approach with active skin warming to maintain perioperative normothermia.
All the patient undergoing surgery for more than 30 minutes should receive an accurate temperature monitoring and a correct management for the maintenance of normothermia. Reducing the incidence and severity of perioperative hypothermia has the potential for drastically reducing complication-related costs.
围手术期体温过低是常见现象，可导致多种并发症，对患者预后产生不利影响，在高危患者中尤为如此。然而，临床常规中并不经常监测中心体温。本研究旨在阐述轻度围手术期体温过低的并发症、监测技术、预防及治疗措施。
我们回顾了关于轻度术中体温过低的心血管、出血、感染及其他临床后果、流行病学及技术、体温监测以及不同预防和治疗轻度体温过低方法的疗效的文献。
体温过低患者发生心血管、出血和感染并发症的频率显著高于体温正常的患者。老年患者和高危患者更容易发生围手术期体温过低，且更易出现与体温过低相关的并发症。必须根据患者特征和手术过程选择理想的监测部位。一旦确定体温过低，就必须进行治疗，最有效的系统是主动式强制空气皮肤加温系统。术前主动预热也已证明可有效减少术中体温过低的发生。当与主动皮肤加温以维持围手术期正常体温的多模式方法一起使用时，湿化和加温吸入气体以及加温静脉输液是有用的技术。
所有手术时间超过30分钟的患者都应接受准确的体温监测及维持正常体温的正确管理。降低围手术期体温过低的发生率和严重程度有可能大幅降低与并发症相关的成本。
