Torossian Alexander, Bräuer Anselm, Höcker Jan, Bein Berthold, Wulf Hinnerk, Horn Ernst-Peter
Clinic of Anesthesiology and Intensive Care Medicine, UKGM Giessen and Marburg, Marburg, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Department of Anaesthesia and Surgical Critical Care, Asklepios Clinic St. Georg, Hamburg, Department of Anaesthesiology and Intensive Care Medicine, Regio Kliniken Pinneberg.
Dtsch Arztebl Int. 2015 Mar 6;112(10):166-72. doi: 10.3238/arztebl.2015.0166.
25-90% of all patients undergoing elective surgery suffer from inadvertent postoperative hypothermia, i.e., a core body temperature below 36°C. Compared to normothermic patients, these patients have more frequent wound infections (relative risk [RR] 3.25, 95% confidence interval [CI] 1.35-7.84), cardiac complications (RR 4.49, 95% CI 1.00-20.16), and blood transfusions (RR 1.33, 95% CI 1.06-1.66). Hypothermic patients feel uncomfortable, and shivering raises oxygen consumption by about 40%.
This guideline is based on a systematic review of the literature up to and including October 2012 and a further one from November 2012 to August 2014. The recommendations were developed and agreed upon by representatives of five medical specialty societies in a structured consensus process.
The patient's core temperature should be measured 1-2 hours before the start of anesthesia, and either continuously or every 15 minutes during surgery. Depending on the nature of the operation, the site of temperature measurement should be oral, naso-/oropharyngeal, esophageal, vesical, or tympanic (direct). The patient should be actively prewarmed 20-30 minutes before surgery to counteract the decline in temperature. Prewarmed patients must be actively warmed intraoperatively as well if the planned duration of anesthesia is longer than 60 minutes (without prewarming, 30 minutes). The ambient temperature in the operating room should be at least 21°C for adult patients and at least 24°C for children. Infusions and blood transfusions that are given at rates of >500 mL/h should be warmed first. Perioperatively, the largest possible area of the body surface should be thermally insulated. Emergence from general anesthesia should take place at normal body temperature. Postoperative hypothermia, if present, should be treated by the administration of convective or conductive heat until normothermia is achieved. Shivering can be treated with medications.
Inadvertent perioperative hypothermia can adversely affect the outcome of surgery and the patient's postoperative course. It should be actively prevented.
接受择期手术的所有患者中有25% - 90%会发生意外的术后体温过低，即核心体温低于36°C。与体温正常的患者相比，这些患者伤口感染（相对风险[RR] 3.25，95%置信区间[CI] 1.35 - 7.84）、心脏并发症（RR 4.49，95% CI 1.00 - 20.16）和输血（RR 1.33，95% CI 1.06 - 1.66）的发生率更高。体温过低的患者会感觉不适，寒战会使耗氧量增加约40%。
本指南基于对截至2012年10月（包括该月）的文献的系统综述以及2012年11月至2014年8月的另一项综述。这些建议是由五个医学专业学会的代表在一个结构化的共识过程中制定并达成一致的。
应在麻醉开始前1 - 2小时测量患者的核心体温，手术期间应连续或每隔15分钟测量一次。根据手术性质，体温测量部位应为口腔、鼻/口咽、食管、膀胱或鼓膜（直接测量）。患者应在手术前20 - 30分钟积极进行预加温，以抵消体温下降。如果计划的麻醉持续时间超过60分钟（未预加温则为30分钟），预加温的患者术中也必须积极加温。手术室的环境温度对于成年患者应至少为21°C，对于儿童应至少为24°C。以>500 mL/h的速度输注的液体和输血应先进行加温。围手术期，应尽可能大面积地对体表进行保温。全身麻醉苏醒应在正常体温下进行。如果出现术后体温过低，应通过给予对流热或传导热进行治疗，直至达到正常体温。寒战可用药物治疗。
围手术期意外体温过低会对手术结果和患者术后病程产生不利影响。应积极预防。
