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成人肝移植期间主动气道加温对机体核心温度的影响。

Effect of active airway warming on body core temperature during adult liver transplantation.

作者信息

Han S B, Gwak M S, Choi S J, Kim M H, Ko J S, Kim G S, Joo H S

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Transplant Proc. 2013 Jan-Feb;45(1):251-4. doi: 10.1016/j.transproceed.2012.05.088.

Abstract

INTRODUCTION

Active inspired gas humidification (AH) preserves body heat and maintains normothermia intraoperatively. However, it is unclear whether AH shows comparable influences during liver transplantation (OLT), which may be affected by both large internal heat loss and external heat supply. Thus, the aim of this study was to evaluate the effect of AH compared with passive humidification (PH) on body temperature in OLT.

MATERIALS AND METHODS

Thirty-four adult patients undergoing living donor OLT were randomly enrolled into two groups: those given AH using a heated humidifier (HH group, n = 17) and those using a heat-and-moisture exchanger (HME group, n = 17). Both core and skin temperatures (Tc and Ts), as well as respiratory parameters, including static/dynamic lung compliances and PaO(2), were recorded at predetermined times.

RESULTS

Both Tc and Ts were consistently higher among the HH versus the HME group after 2 hours of anesthesia. Differences in Tc and Ts between the two groups increased gradually over time. The overall Tc during surgery was higher among the HH than the HME group (P = .023). The incidences of hypothermia were lower in the HH group at 3 hours of anesthesia, 1 and 3 hours of reperfusion, and at the end of surgery (P = .037, 0.024, 0.005, and 0.010 respectively). The duration of hypothermia was lower in the HH than the HME group (3.9 ± 3.5 hours versus 6.7 ± 3.3 hours, P = .025). Both groups showed no significant intraoperative changes in respiratory parameters; there were no postoperative respiratory complications.

CONCLUSION

Active humidification warms the patient's body effectively, lessening the incidence and duration of hypothermia during OLT with no respiratory risks.

摘要

引言

主动湿化吸入气体(AH)可保存体温并在术中维持正常体温。然而,在肝移植(OLT)过程中AH是否具有类似影响尚不清楚,OLT可能受到大量内部热量散失和外部热量供应的双重影响。因此,本研究旨在评估与被动湿化(PH)相比,AH对OLT患者体温的影响。

材料与方法

34例接受活体供肝OLT的成年患者被随机分为两组:使用加热湿化器进行AH的患者(HH组,n = 17)和使用热湿交换器的患者(HME组,n = 17)。在预定时间记录核心温度和皮肤温度(Tc和Ts)以及呼吸参数,包括静态/动态肺顺应性和PaO₂。

结果

麻醉2小时后,HH组的Tc和Ts始终高于HME组。两组之间Tc和Ts的差异随时间逐渐增加。手术期间HH组的总体Tc高于HME组(P = 0.023)。在麻醉3小时、再灌注1小时和3小时以及手术结束时,HH组体温过低的发生率较低(分别为P = 0.037、0.024、0.005和0.010)。HH组体温过低的持续时间低于HME组(3.9±3.5小时对6.7±3.3小时,P = 0.025)。两组术中呼吸参数均无显著变化;术后无呼吸并发症。

结论

主动湿化可有效温暖患者身体,降低OLT期间体温过低的发生率和持续时间,且无呼吸风险。

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