护士主导的强制空气加热毯对降低冠状动脉旁路移植术后低体温并发症的效果：一项随机临床试验。

Effect of nurse-initiated forced-air warming blanket on the reduction of hypothermia complications following coronary artery bypass grafting: a randomized clinical trial.

机构信息

Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), Departamento de Enfermagem Clínica e Cirúrgica and Programa de Pós Graduação em Enfermagem, 754 Napoleão de Barros St, Vila Clementino, São Paulo-SP, 04024-002, Brazil.

Instituto Dante Pazzanese de Cardiologia (IDPC), Divisão de Enfermagem. 500 Dr Dante Pazzanese Av, Ibirapuera, São Paulo-SP, 04012-909, Brazil.

出版信息

Eur J Cardiovasc Nurs. 2021 Jun 29;20(5):445-453. doi: 10.1093/eurjcn/zvaa023.

DOI:10.1093/eurjcn/zvaa023

PMID:33620461

Abstract

AIMS

To evaluate the effect of postoperative forced-air warming (FAW) on the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial infarction (AMI), and blood product transfusion in hypothermic patients following on-pump CABG and compare temperatures associated with the use of FAW and warming with a sheet and wool blanket.

METHODS AND RESULTS

A randomized clinical trial conducted with 200 patients undergoing isolated on-pump CABG from January to November 2018. Patients were randomly assigned into an Intervention Group (IG, FAW, n = 100) and Control Group (CG, sheet and blanket, n = 100). The tympanic temperature of all patients was measured over a 24-h period. ExB was the primary outcome, while arrhythmia, AMI, and blood product transfusion were secondary outcomes. The effect of the interventions on the outcomes was investigated through using bivariate logistic regression, with a level of significance of 5%. The IG was 79% less likely to experience bleeding than the CG [odds ratio (OR) = 0.21, confidence interval (CI) 95% 0.12-0.39, P < 0.001]; the occurrence of AMI in the IG was 94% lower than that experienced by the CG (OR = 0.06, CI 95% 0.01-0.48, P < 0.001); and the IG was also 77% less likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12-0.47, P < 0.001); no difference was found between groups in terms of blood product transfusion (P < 0.279).

CONCLUSIONS

These findings show that FAW can be used following CABG until patients reach normothermia to avoid undesirable clinical outcomes.

TRIAL REGISTRATION

REBeC RBR-5t582g.

摘要

目的

评估体外循环冠状动脉旁路移植术（CABG）后使用术后强制空气加热（FAW）对低体温患者发生过度出血（ExB）、心律失常、急性心肌梗死（AMI）和输血的影响，并比较 FAW 和使用毯子和羊毛毯加热的温度。

方法和结果

这是一项 2018 年 1 月至 11 月期间对 200 例接受体外循环 CABG 的患者进行的随机临床试验。患者被随机分为干预组（IG，FAW，n=100）和对照组（CG，毯子和毯子，n=100）。所有患者的鼓膜温度在 24 小时内进行测量。ExB 是主要结局，心律失常、AMI 和输血是次要结局。通过二元逻辑回归分析干预措施对结局的影响，显著性水平为 5%。IG 发生出血的可能性比 CG 低 79%[比值比（OR）=0.21，95%置信区间（CI）0.12-0.39，P<0.001]；IG 发生 AMI 的可能性比 CG 低 94%（OR=0.06，95%CI 0.01-0.48，P<0.001）；IG 发生心律失常的可能性也比 CG 低 77%（OR=0.23，95%CI 0.12-0.47，P<0.001）；两组在输血方面无差异（P<0.279）。