Osguthorpe S G
AACN Clin Issues Crit Care Nurs. 1993 May;4(2):276-92.
Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pretreatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. These techniques optimize myocardial preservation while providing adequate cardiac surgery operative times by decreasing the myocardial ischemic period, decreasing cellular metabolic requirements, and preserving energy stores. Awareness of the physiologic consequences of hypothermia in the postoperative cardiac patient improves nursing assessment of the hypothermic patient. Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient.
在心脏手术中，确保向组织输送与氧需求相匹配的充足氧气是一项重要的手术挑战。20世纪90年代心肌保护的先进技术已发展到包括心肌预处理；术中使用体外循环（CPB）进行全身低温、心肌局部降温、冷心脏停搏液和心肌再灌注；以及术后氧输送支持。这些技术通过缩短心肌缺血期、降低细胞代谢需求和保存能量储备，优化心肌保护，同时提供足够的心脏手术操作时间。了解心脏术后患者低温的生理后果有助于护士对低温患者进行评估。适当的体温监测和报告有助于为低温患者及时采取医疗和护理干预措施，如体内和体外复温技术或药物治疗，以促进复温过程并抑制或治疗寒战。本文探讨了低温的生理状况、心脏手术中使用的选择性低温技术，以及心脏术后患者的医疗或护理复温和管理技术。
