术中采用零热流技术（3M SpotOn）监测皮肤温度与食管和动脉温度的比较：一项前瞻性观察研究。
Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study.
机构信息
From the Service d'anesthésie-réanimation, CHU de Poitiers (MB, AA, TK, BD, CD-F, DF), Université de Poitiers, UFR Médecine-Pharmacie (MB, TK, OM, BD, CD-F, DF), Inserm U1070, Pôle Biologie Santé (MB, OM, CD-F), Service des Urgences Adultes - SAMU 86, CHU de Poitiers, Poitiers (OM) and Inserm U1246, SPHERE, Methods in Patients-Centered Outcomes and Health Research, Nantes, France (DF).
出版信息
Eur J Anaesthesiol. 2018 Nov;35(11):825-830. doi: 10.1097/EJA.0000000000000822.
BACKGROUND
Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC).
OBJECTIVE
To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min.
DESIGN
Prospective observational study.
SETTING
Operating rooms at the University Hospital of Poitiers, France.
PATIENTS
Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy.
INTERVENTION
Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery.
MAIN OUTCOME MEASURES
Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes.
RESULTS
Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were -0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated.
CONCLUSION
A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02869828.
背景
在大型手术中，连续监测核心体温对于提高患者安全性至关重要。食道探头或特定的动脉导管是该环境下的侵入性方法。一种基于零热通量（ZHF）技术的新型非侵入性设备（SpotOn）似乎很有前途，但在快速核心温度变化（RCTC）期间研究甚少。
目的
评估 SpotOn 传感器与食道探头或特定动脉导管在 30 分钟内核心温度变化小于 1°C 且 RCTC 大于 1°C 时的准确性。
设计
前瞻性观察性研究。
地点
法国普瓦捷大学医院手术室。
患者
2015 年 6 月至 2016 年 3 月期间，纳入 50 名接受全身麻醉下大型腹部手术的患者。最终对 49 名患者的数据进行了分析。其中，15 名患者接受了腹腔内热化疗治疗。
干预
每位患者在前额皮肤表面放置一个 ZHF 传感器（TempZHF）和一个食道探头（TempEso）作为参考方法。22 名患者还在腋动脉内置入热稀释动脉导管（TempArt）。
主要观察指标
麻醉诱导后，从三个设备连续记录核心温度。根据核心温度变化速度，使用 Bland 和 Altman 方法在两个不同时间段内比较两种方法的温度测量结果。
结果
与 TempEso 相比，TempZHF 在缓慢的核心温度变化期间的偏差和一致性界限为 0.1°C±0.5°C，在 RCTC 期间为 0.6°C±1.8°C（P=0.0002）。与 TempArt 相比，这些值分别为-0.1°C±0.4°C 和 0.5°C±1.7°C（P=0.0039）。ZHF 传感器耐受性良好。
结论
在腹部手术中，当核心温度变化缓慢而非快速时，使用 ZHF 方法的 SpotOn 传感器似乎可用于可靠地监测核心体温。
试验注册
ClinicalTrials.gov 标识符：NCT02869828。
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