The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia.
Int J Evid Based Healthc. 2011 Dec;9(4):337-45. doi: 10.1111/j.1744-1609.2011.00227.x.
Inadvertent hypothermia is common in patients undergoing surgical procedures with a reported prevalence of perioperative hypothermia ranging from 50% to 90%. Hypothermia within the perioperative environment may have many undesired physiological effects that are associated with postoperative morbidity. There are different options for treating and/or preventing hypothermia within the adult perioperative environment, which include active and passive warming methods. This systematic review was undertaken to provide comprehensive evidence on the most effective strategies for prevention and management of inadvertent hypothermia in the perioperative environment.
The objective of this review was to identify the most effective methods for the treatment and/or preventions of hypothermia in intraoperative or postoperative patients.
Adult patients ≥ 18 years of age, who underwent any type of surgery were included in this review. Types of interventions included were any type of linen or cover, aluminium foil wraps, forced-air warming devices, radiant warming devices and fluid warming devices. This review considered all identified prospective studies that used a clearly described process for randomisation, and/or included a control group. The primary outcome of interest was change in core body temperature.
Two independent reviewers assessed methodological validity of papers selected for retrieval and any disagreements were resolved through discussion.
Nineteen studies with a combined 1451 patients who underwent different surgical procedures were included in this review. Meta-analysis was not possible. Forced-air warming in pregnant women scheduled for caesarean delivery under regional anaesthesia prevented maternal and foetal hypothermia. Intravenous and irrigating fluids warmed (38-40°C) to a temperature higher than that of room temperature by different fluid warming devices (both dry and water heated) proved significantly beneficial to patients in terms of stable haemodynamic variables, and higher core temperature at the end of the surgery. Water garment warmer was significantly (P < 0.05) effective than forced-air warming in maintaining intraoperative normothermia in orthotopic liver transplantation patients. Extra warming with forced air compared to routine thermal care was effective in reducing the incidence of surgical wound infections and postoperative cardiac complications. Passive warming with reflective heating blankets or elastic bandages wrapped around the legs tightly were found to be ineffective in reducing the incidence or magnitude of hypothermia.
There are significant benefits associated with forced-air warming. Evidence supports commencement of active warming preoperatively and monitoring it throughout the intraoperative period. Single strategies such as forced-air warming were more effective than passive warming; however, combined strategies, including preoperative commencement, use of warmed fluids plus forced-air warming as other active strategies were more effective in vulnerable groups (age or durations of surgeries).
在接受手术的患者中，意外低体温很常见，据报道围手术期低体温的患病率为 50%至 90%。围手术期环境中的低体温可能会产生许多不良的生理影响，与术后发病率有关。在成人围手术期环境中，有多种治疗和/或预防低体温的选择，包括主动和被动加热方法。本系统评价旨在提供全面的证据，说明预防和管理围手术期意外低体温最有效的策略。
本综述的目的是确定治疗和/或预防术中或术后患者低体温最有效的方法。
年龄≥ 18 岁，接受任何类型手术的成年患者均纳入本研究。干预措施包括任何类型的床单或覆盖物、铝箔包裹物、强制空气加热设备、辐射加热设备和液体加热设备。本综述考虑了所有已确定的前瞻性研究，这些研究使用了明确描述的随机化过程，并且/或者包括对照组。主要观察指标是核心体温的变化。
两名独立评审员评估所选检索论文的方法学有效性，任何分歧均通过讨论解决。
共有 19 项研究纳入了 1451 名接受不同手术的患者，共纳入了 19 项研究。由于 Meta 分析不可行，因此未进行 Meta 分析。对于接受区域麻醉下剖宫产的孕妇，强制空气加热可预防母婴低体温。与室温相比，通过不同的液体加热设备（干式和水加热）将静脉内和冲洗液加热（38-40°C）到更高的温度，对患者有显著益处，在手术结束时可保持稳定的血流动力学变量和更高的核心体温。水服加热器在维持原位肝移植患者术中正常体温方面明显（P < 0.05）优于强制空气加热。与常规热护理相比，使用强制空气进行额外的加热可有效降低手术部位感染和术后心脏并发症的发生率。被动加热用反射加热毯或弹性绷带紧紧包裹腿部被发现对降低低体温的发生率或幅度没有效果。
强制空气加热有明显的益处。证据支持在术前开始主动加热，并在整个手术过程中进行监测。单一策略（如强制空气加热）比被动加热更有效；然而，在脆弱人群（年龄或手术时间）中，联合策略（包括术前开始、使用加热的液体加上强制空气作为其他主动策略）更有效。
