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术中意外低体温

Inadvertent intraoperative hypothermia.

作者信息

Horosz Bartosz, Malec-Milewska Małgorzata

机构信息

Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland.

出版信息

Anaesthesiol Intensive Ther. 2013 Jan-Mar;45(1):38-43. doi: 10.5603/AIT.2013.0009.

Abstract

Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. This is due to a combination of anaesthesia-related impairment of the central thermoregulatory control and a cool operating room temperature, which, when superimposed on insufficient insulation and a failure to actively warm the patient, may result in profound temperature disturbances. As a result, prolonged wound healing, increased risk of wound infection, a higher rate of cardiac morbidity, and greater intraoperative blood loss and postoperative blood transfusion requirements may occur. The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort.

摘要

围手术期意外体温过低在很大比例的外科手术中都会出现并发症,且与多种因素相关。在正常情况下严格调控(±0.2°C),麻醉患者的核心体温可能会下降多达6°C,而下降2°C则非常常见。这是由于与麻醉相关的中枢体温调节控制受损以及手术室温度较低共同作用的结果,再加上保温不足以及未能积极为患者保暖,可能会导致严重的体温紊乱。结果可能会出现伤口愈合延长、伤口感染风险增加、心脏发病率更高以及术中失血量增加和术后输血需求增加等情况。据说其原因包括微循环、凝血、免疫学方面的潜在变化以及大多数麻醉药物作用时间延长。由于有效的方法已经存在多年,目前建议维持术中正常体温,以将手术相关风险降至最低并提高患者舒适度。

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