Cantürk Mehmet, Cantürk Fusun Karbancioglu, Kocaoğlu Nazan, Hakki Meltem
Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia.
Ahi Evran University Training and Research Hospital, Department of Obstetrics and Gynecology, Kırsehir, Turquia.
Braz J Anesthesiol. 2019 Jan-Feb;69(1):13-19. doi: 10.1016/j.bjan.2018.09.009. Epub 2018 Nov 15.
Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia.
In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3–L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section.
There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation ( = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups.
Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.
约60%的麻醉患者会出现体温过低，且在短期手术过程中通常未得到妥善处理。体温过低与不良临床结局相关。本研究旨在评估晶体液加温对接受腰麻择期剖宫产患者母婴结局的影响。
在这项前瞻性随机对照试验中，60例计划接受腰麻择期剖宫产的产妇被随机分配接受室温晶体液或37℃加温的晶体液。在L3 - L4间隙进行腰麻，使用10mg重比重布比卡因，不添加阿片类药物。每隔1分钟测量核心体温、寒战和血流动力学参数，直至第10分钟，之后每隔5分钟测量直至手术结束。主要结局是剖宫产结束时产妇的核心体温。
基线鼓膜温度测量无差异，但手术结束时差异显著（P = 0.004）。等温加温晶体液组基线核心体温为36.8±0.5℃，手术结束时降至36.3±0.5℃；室温组基线鼓膜核心体温为36.9±0.4℃，手术结束时降至35.8±0.7℃。对照组有43.3%的患者出现寒战。两组间血流动力学参数变化和人口统计学数据无显著差异。
等温加温晶体液可防止足月产妇在腰麻剖宫产过程中核心体温下降。等温加温时胎儿1分钟和5分钟Apgar评分更高。
