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成年择期手术患者围手术期低体温的预防与管理:一项系统评价

Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review.

作者信息

Simegn Getamesay Demelash, Bayable Samuel Debas, Fetene Melaku Bantie

机构信息

Department of Anaesthesia, College of Medicine and Health Science, Debre Markos University, Ethiopia.

出版信息

Ann Med Surg (Lond). 2021 Nov 14;72:103059. doi: 10.1016/j.amsu.2021.103059. eCollection 2021 Dec.

Abstract

BACKGROUND

Body temperature is tightly regulated with hormonal and cellular metabolism for normal functioning; however perioperative hypothermia is common secondary to anesthesia and surgical exposure.Prevention and maintaining body temperature should be started 1-2hrs before induction of anesthesia, to do this both active and passive warming system are effective to prevent complications associated with perioperative hypothermia.

METHODS

The aim of this systematic review is to develop a clear clinical practice protocol in prevention and management of perioperative hypothermia for elective adult surgical patients.The study is conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020. After formulating clear criteria for the evidences to be included an appropriate method of searching was conducted by using the Pub Med, Google scholar and Cochrane library using the following MeSH terms: (inadvertent hypothermia AND anesthesia, hypothermia AND perioperative management and thermoregulation AND anesthesia) were used to draw evidences.After a reasonable amount of evidences were collected, appraisal and evaluation of study quality was based on WHO 2011 level of evidence and degree of recommendation. Final conclusions and recommendations are done by balancing the benefits and downsides of alternative management strategies for perioperative management of hypothermia.This systematic review registered with research registry unique identifying number (UIN) of "" in addition the overall AMSTAR 2 quality of this systematic review is .

DISCUSSION

Preserving a patient's body temperature during anesthesia and surgery is to minimize heat loss by reducing radiation and convection from the skin, evaporation from exposed surgical areas, and cooling caused by the introduction of cold intravenous fluids.

CONCLUSION

Hypothermia is least monitored complication during anesthesia and surgery results cardiac abnormalities, impaired wound healing, increased surgical site infections, shivering and delayed postoperative recovery, and coagulopathies.

摘要

背景

体温通过激素和细胞代谢进行严格调节以维持正常功能;然而,围手术期体温过低在麻醉和手术暴露后很常见。预防和维持体温应在麻醉诱导前1 - 2小时开始,为此主动和被动升温系统对于预防围手术期体温过低相关并发症均有效。

方法

本系统评价的目的是为择期成年手术患者制定一份清晰的围手术期体温过低预防和管理临床实践方案。该研究按照2020年系统评价和Meta分析的首选报告项目(PRISMA)指南进行。在制定明确的纳入证据标准后,通过使用以下医学主题词在PubMed、谷歌学术和考克兰图书馆进行适当的检索方法:(意外体温过低与麻醉、体温过低与围手术期管理、体温调节与麻醉)来获取证据。在收集了合理数量的证据后,基于世界卫生组织2011年的证据水平和推荐程度对研究质量进行评估。通过权衡围手术期体温过低替代管理策略的利弊得出最终结论和建议。本系统评价在研究注册库注册,唯一识别编号(UIN)为“”,此外本系统评价的整体AMSTAR 2质量为 。

讨论

在麻醉和手术期间保持患者体温是为了通过减少皮肤的辐射和对流、暴露手术区域的蒸发以及冷静脉输液引起的降温来尽量减少热量损失。

结论

体温过低是麻醉和手术期间监测最少的并发症,会导致心脏异常、伤口愈合受损、手术部位感染增加、寒战、术后恢复延迟和凝血功能障碍。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e43f/8605381/a79184a0a45d/gr1.jpg

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