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预防围手术期意外低温

Prevention of inadvertent perioperative hypothermia.

作者信息

Burger Leona, Fitzpatrick Jane

机构信息

Royal United Hospital, England.

出版信息

Br J Nurs. 2009;18(18):1114, 1116-9. doi: 10.12968/bjon.2009.18.18.44553.

DOI:10.12968/bjon.2009.18.18.44553
PMID:19966730
Abstract

All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient's body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients' short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forced-air warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period.

摘要

所有接受手术的患者都有发生体温过低的风险;高达70%的患者在围手术期会出现体温过低。意外体温过低与伤口愈合受损、失血增加、心脏骤停以及伤口感染风险增加等并发症相关。麻醉会增加这种风险,因为正常的保护性寒战反射消失了。环境温度对患者体温也有重大影响。预防体温过低不仅能降低并发症的发生率,患者还会感觉更舒适,避免术后寒战以及寒冷的不适感。护士应意识到体温过低的风险,以便采取预防性干预措施将体温过低的风险降至最低。术前评估对于识别高危患者至关重要。护士采取的简单预防措施可显著减少热量散失,将相关并发症的风险降至最低,并最终改善患者的短期和长期恢复情况。尽量减少皮肤暴露、为转运至手术室提供足够的床单以及对患者进行围手术期保暖重要性的教育都极为重要。术前考虑使用强制空气加温器也值得一试,因为研究表明术前开始主动加温可能成功预防围手术期体温过低。

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