Munday Judy, Osborne Sonya, Yates Patsy, Sturgess David, Jones Lee, Gosden Edward
From the Mater Health Services, Raymond Terrace, South Brisbane, Australia.
School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia.
Anesth Analg. 2018 Jan;126(1):183-189. doi: 10.1213/ANE.0000000000002026.
Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss.
A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming (plus intravenous fluid warming) versus no active preoperative warming (plus intravenous fluid warming) in 50 healthy American Society of Anesthesiologists graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery. The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals. Secondary outcomes included maternal thermal comfort, shivering, mean arterial pressure, agreement between aural temperature, and neonatal outcomes (axillary temperature at birth, Apgar scores, breastfeeding, and skin-to-skin contact). The intention-to-treat population was analyzed with descriptive statistics, general linear model analysis, linear mixed-model analysis, χ test of independence, Mann-Whitney, and Bland-Altman analysis. Full ethical approval was obtained, and the study was registered on the Australia and New Zealand Clinical Trials Registry (Trial No: 367160, registered at http://www.ANZCTR.org.au/).
Intention-to-treat analysis (n = 50) revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups: F (1, 47) = 1.2, P = .28. There were no other statistically significant differences between groups in any of the secondary outcomes.
A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population.
剖宫产脊髓麻醉的女性体温过低发生率较高，因此预防很有必要。本试验比较了术前保暖与常规护理在接受鞘内注射吗啡的女性中的效果，鞘内注射吗啡被认为会加剧围手术期热量流失。
一项前瞻性、单盲、随机对照试验，比较了50例健康的美国麻醉医师协会分级为II级、接受鞘内注射吗啡作为择期剖宫产脊髓麻醉一部分的女性，20分钟的强制空气加温（加静脉输液加温）与术前无主动加温（加静脉输液加温）的效果。通过定期测量耳道和膀胱温度来评估产妇体温变化的主要结局。次要结局包括产妇的热舒适度、寒战、平均动脉压、耳道温度之间的一致性以及新生儿结局（出生时腋窝温度、阿氏评分、母乳喂养和皮肤接触）。采用描述性统计、一般线性模型分析、线性混合模型分析、独立性χ检验、曼-惠特尼检验和布兰德-奥特曼分析对意向性分析人群进行分析。已获得全面伦理批准，该研究已在澳大利亚和新西兰临床试验注册中心注册（试验编号：367160，注册于http://www.ANZCTR.org.au/）。
意向性分析（n = 50）显示，两组从基线到手术结束时耳道温度变化无显著差异：F(1, 47) = 1.2，P = 0.28。在任何次要结局中，两组之间均无其他统计学显著差异。
术前短时间加温对接受鞘内注射吗啡的女性预防术中体温下降无效。该人群可能需要术前和术中加温方式相结合。
