Department of Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Plastic Surgery, Faculty of Medicine, University of Basel, Basel, Switzerland.
J Plast Reconstr Aesthet Surg. 2020 Sep;73(9):1645-1664. doi: 10.1016/j.bjps.2020.05.025. Epub 2020 May 21.
Optimising patients pre-operatively reduces the chance of complications. This may be achieved by preconditioning. Thermal preconditioning refers to the supraphysiological heating of organisms or specific organs prior to an environmental insult. This review explores the current application and efficacy of thermal preconditioning for surgery.
A comprehensive search of Medline (via PubMed), Embase and the Cochrane library was performed. Only articles evaluating the use of supraphysiological heating prior to a surgical intervention were included. Qualitative syntheses of data were undertaken due to the heterogeneity of the studies. The quality of each article was appraised using risk of bias tools (Cochrane and SYRCLE).
The primary literature search returned 3175 articles. After screening and reviewing reference lists, 28 papers met the inclusion criteria. The majority of studies were performed in animals, with only three clinical trials. Although there was broad coverage of different surgical techniques, flap transfer was the most commonly performed procedure. Most studies demonstrated a beneficial effect of thermal preconditioning, ranging from increased joint mobility to improved flap or organ transplant survival rates. The quality of evidence was variable, with experimental animal studies limited by a lack of methodological detail.
Thermal preconditioning for surgery has been primarily investigated using animal models. A beneficial effect has been demonstrated in most cases, across specialties ranging from plastic to general surgery. Future studies should aim to assess the clinical significance through large multicentre randomised controlled trials.
优化患者的术前状态可以降低并发症发生的几率。这可以通过预处理来实现。热预处理是指在机体或特定器官受到环境损伤之前，采用高于生理状态的温度进行加热。本综述探讨了热预处理在外科手术中的应用和效果。
对 Medline（通过 PubMed）、Embase 和 Cochrane 图书馆进行了全面检索。仅纳入评估在外科干预前采用超生理温度加热的研究。由于研究的异质性，对数据进行了定性综合。使用偏倚风险工具（Cochrane 和 SYRCLE）评估了每篇文章的质量。
初步文献检索返回了 3175 篇文章。经过筛选和查阅参考文献，有 28 篇论文符合纳入标准。大多数研究是在动物身上进行的，只有三项临床试验。尽管涵盖了不同的外科技术，但皮瓣转移是最常进行的手术。大多数研究表明热预处理具有有益效果，从增加关节活动度到提高皮瓣或器官移植存活率不等。证据质量参差不齐，由于缺乏方法学细节，实验动物研究受到限制。
外科手术中的热预处理主要通过动物模型进行研究。大多数情况下，从整形外科到普通外科等多个专业都显示出有益的效果。未来的研究应通过大型多中心随机对照试验评估其临床意义。
