Schmied H, Kurz A, Sessler D I, Kozek S, Reiter A
Department of Anaesthesia and Intensive Care Medicine, Hospital of Amstetten, Austria.
Lancet. 1996 Feb 3;347(8997):289-92. doi: 10.1016/s0140-6736(96)90466-3.
In-vitro studies indicate that platelet function and the coagulation cascade are impaired by hypothermia. However, the extent to which perioperative hypothermia influences bleeding during surgery remains unknown. Accordingly, we tested the hypothesis that mild hypothermia increases blood loss and allogeneic transfusion requirements during hip arthroplasty.
Blood loss and transfusion requirements were evaluated in 60 patients undergoing primary, unilateral total hip arthroplasties who were randomly assigned to normothermia (final intraoperative core temperature 36.6 [0.4] degrees C) or mild hypothermia (35.0 [0.5] degrees C). Crystalloid, colloid, scavenged red cells, and allogeneic blood were administered by strict protocol.
Intra- and postoperative blood loss was significantly greater in the hypothermic patients: 2.2 (0.5) L vs 1.7 (0.3) L, p < 0.001). Eight units of allogeneic packed red cells were required in seven of the 30 hypothermic patients, whereas only one normothermic patient required a unit of allogeneic blood (p < 0.05 for administered volume). A typical decrease in core temperature in patients undergoing hip arthroplasty will thus augment blood loss by approximately 500 mL.
The maintenance of intraoperative normothermia reduces blood loss and allogeneic blood requirements in patients undergoing total hip arthroplasty.
体外研究表明，体温过低会损害血小板功能和凝血级联反应。然而，围手术期体温过低对手术期间出血的影响程度尚不清楚。因此，我们检验了以下假设：轻度体温过低会增加髋关节置换术中的失血量和异体输血需求。
对60例行初次单侧全髋关节置换术的患者进行失血量和输血需求评估，这些患者被随机分为正常体温组（术中最终核心体温36.6 [0.4]摄氏度）或轻度体温过低组（35.0 [0.5]摄氏度）。按照严格方案输注晶体液、胶体液、回收红细胞和异体血。
体温过低患者的术中和术后失血量显著更多：2.2（0.5）升对1.7（0.3）升，p<0.001）。30例体温过低患者中有7例需要8单位异体浓缩红细胞，而只有1例正常体温患者需要1单位异体血（输注量p<0.05）。因此，髋关节置换术患者典型的核心体温下降会使失血量增加约500毫升。
在全髋关节置换术患者中，维持术中正常体温可减少失血量和异体血需求。
