作者投稿
专家审稿
编辑办公
邮件订阅
RSS
2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia
-
摘要: 《围术期患者低体温防治专家共识(2023版)》在《围手术期患者低体温防治专家共识(2017)》基础上进行更新。新版共识旨在以患者为中心，以防治围术期意外低体温为目的，为临床医生提供实现优质医疗服务的循证医学证据与建议。该共识对围术期低体温风险评估与预测、常用的体温监测方法以及在术前、术中和术后为患者提供保温措施等方面提出专业建议。此外，共识还对低体温与不良结局，儿科、妊娠、创伤、肝移植和败血症等特殊患者体温管理提供了新的证据。Abstract: The 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia is an update of the 2017 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia. It is intended to provide patient-centric recommendations for clinicians to prevent and manage inadvertent hypothermia. It offers advice on assessing patient's risk of hypothermia, measuring and monitoring temperature as well as preventing patients from hypothermia before, during and after surgery. It also provides new evidence on hypothermia and adverse outcomes, and temprature management for special patients care considerations including pediatric, pregnancy, trauma, liver transplantation and sepsis.
-
Key words:
- perioperative /
- hypothermia /
- prevention /
- management /
- expert consensus
作者贡献：顾小萍负责查阅文献；顾小萍、易杰、裴丽坚负责撰写初稿；黄宇光负责修改完善并审校定稿；其余成员参与修订。利益冲突：共识制订工作组所有参与人员均声明不存在利益冲突共识专家组名单组长：黄宇光(中国医学科学院北京协和医院)成员 (按姓氏首字母排序)：柴小青(中国科学技术大学附属第一医院)，陈骏萍(浙江省宁波市第二医院)，陈世彪(南昌大学第一附属医院)，迟永良(山东省中医院)，都义日(内蒙古医科大学附属医院)，顾小萍(南京大学医学院附属鼓楼医院)，郭曲练(中南大学湘雅医院)，嵇富海(苏州大学附属第一医院)，李洪(陆军军医大学第二附属医院)，李天佐(首都医科大学北京世纪坛医院)，林献忠(福建医科大学附属第一医院)，刘友坦(南方医科大学深圳医院)，陆智杰(海军军医大学第三附属医院)，贾珍(青海大学附属医院)，马正良(南京大学医学院附属鼓楼医院)，欧阳文(中南大学湘雅三医院)，裴丽坚(中国医学科学院北京协和医院)，田首元(山西省肿瘤医院)，王庚(北京积水潭医院)，王国林(天津医科大学总医院)，王晟(北京安贞医院)，王天龙(首都医科大学宣武医院)，夏中元(湖北省人民医院)，徐铭军(首都医科大学附属北京妇产医院)，严敏(浙江大学医学院附属第二医院)，杨建军(郑州大学第一附属医院)，姚兰(北京大学国际医院)，易杰(中国医学科学院北京协和医院)，赵国庆(吉林大学中日联谊医院)，赵平(中国医科大学附属盛京医院)，章放香(贵州省人民医院)，张良成(福建医科大学附属协和医院)，郑晖(中国医学科学院肿瘤医院)，左明章(北京医院)执笔人：顾小萍(南京大学医学院附属鼓楼医院)，易杰(中国医学科学院北京协和医院)，裴丽坚(中国医学科学院北京协和医院) -
表 1 围术期低体温的危险因素
因素 具体描述 患者因素 年龄 年龄＞60岁的患者围术期低体温发生率更高，体温恢复时间也更长；婴幼儿，尤其是早产和低体质量儿更易发生低体温 BMI BMI＜25 kg/m2是围术期低体温的独立危险因素；超重患者有矛盾结论：BMI越大，热量散失越快；但肥胖患者由于脂肪保护作用，体表散热减少，核心体温与体表温度差值减小；内脏型肥胖患者的腰臀比可作为腔镜手术低体温发生的危险因素之一 ASA分级 ASA Ⅱ级以上患者低体温发生率高于ASA Ⅰ级患者，且ASA分级越高，围术期低体温发生风险越高 基础体温 基础体温是影响围术期低体温的独立高风险因素，术前体温偏低患者围术期低体温发生风险明显增高 合并症 合并代谢性疾病可影响体温：如糖尿病合并神经病变患者围术期低体温发生风险增加 手术因素 手术分级 手术分级越高，患者围术期低体温发生率越高 手术类型 开放性手术体腔暴露，腔镜手术建立CO2气腹及术中大量冲洗液均易导致围术期低体温的发生 手术时间 手术时间超过2 h，围术期低体温发生率明显增高，全身麻醉患者尤甚 术中冲洗 使用超过1000 mL未加温冲洗液，患者围术期低体温发生率增高 术中输液/输血 静脉输注1000 mL室温晶体液或1个单位2~6 ℃库存血，可使体温下降0.25~0.5 ℃；静脉输注未加温液体超过1000 mL时，围术期低体温发生风险增高 麻醉因素 麻醉方式 全身麻醉较椎管内或区域麻醉围术期低体温发生率高；复合麻醉方式(如全身麻醉复合椎管内或区域麻醉)较单纯全身麻醉围术期低体温发生率高 麻醉平面 椎管内麻醉平面越高，核心体温越低 麻醉时间 麻醉时间超过2 h, 患者围术期低体温发生率增高 麻醉药物 吸入性麻醉药、静脉麻醉药及麻醉性镇痛药均可影响体温调节机制，导致围术期低体温发生 环境因素 手术室温度 增加环境温度对患者围术期低体温的发生具有保护作用，通常低于21 ℃患者低体温发生风险增高 BMI：体质量指数；ASA：美国麻醉医师协会 
下载: 导出CSV
表 3 围术期体温监测
项目 具体描述 体温监测时长 理想状态下，体温监测应具连续性，涵盖术前、术中和术后 体温监测频率 术前 接患者前，应在病房测量1次；手术等候区可每15~30分钟测量1次 术中 记录入室和出室体温，推荐连续监测体温，可每15~30分钟测量1次，直至手术结束 术后 记录出入麻醉恢复室体温，连续监测体温，至少每15~30分钟测量1次 体温监测部位 核心体温 肺动脉、食管下段1/3、鼻咽部(鼻孔至鼻咽上部1/3)、鼓膜；在全身麻醉期间，食管或鼻咽通常是最实用的体温监测部位 近似核心体温 规范测量的口腔、腋窝温度可近似于核心体温，适用于椎管内麻醉、区域阻滞患者；相反，膀胱、直肠温度欠准确，并存在延迟效应
下载: 导出CSV
-
[1] Sessler DI. Mild perioperative hypothermia[J]. N Engl J Med, 1997, 336: 1730-1737. doi: 10.1056/NEJM199706123362407 [2] Mendonça FT, Ferreira J, Guilardi V, et al. Prevalence of inadvertent perioperative hypothermia and associated factors: a cross-sectional study[J]. Ther Hypothermia Temp Manag, 2021, 11: 208-215. doi: 10.1089/ther.2020.0038 [3] Akers JL, Dupnick AC, Hillman EL, et al. Inadvertent perioperative hypothermia risks and postoperative complications: a retrospective study[J]. AORN J, 2019, 109: 741-747. doi: 10.1002/aorn.12696 [4] Brustia R, Monsel A, Skurzak S, et al. Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations[J]. Transplantation, 2022, 106: 552-561. doi: 10.1097/TP.0000000000003808 [5] 国家麻醉专业质量控制中心, 中华医学会麻醉学分会. 围手术期患者低体温防治专家共识(2017)[J]. 协和医学杂志, 2017, 8: 352-358. doi: 10.3969/j.issn.1674-9081.2017.06.007 [6] 陈颖, 王莹, 张越伦, 等. 全麻患者围手术期低体温风险预测模型的前瞻性、多中心研究[J]. 中国医学科学院学报, 2022, 44: 1028-1032. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX202206012.htm [7] 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版)[J]. 中华医学杂志, 2022, 102: 697-703. doi: 10.3760/cma.j.cn112137-20211228-02911 [8] Collins S, Budds M, Raines C, et al. Risk factors for perioperative hypothermia: a literature review[J]. J Perianesth Nurs, 2019, 34: 338-346. doi: 10.1016/j.jopan.2018.06.003 [9] Sari S, Aksoy SM, But A. The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors[J]. Int J Clin Pract, 2021, 75: e14103. [10] Scott AV, Stonemetz JL, Wasey JO, et al. Compliance with surgical care improvement project for body temperature management (SCIP Inf-10) is associated with improved clinical outcomes[J]. Anesthesiology, 2015, 123: 116-125. doi: 10.1097/ALN.0000000000000681 [11] Sessler DI. Perioperative thermoregulation and heat balance[J]. Lancet, 2016, 387: 2655-2664. doi: 10.1016/S0140-6736(15)00981-2 [12] Lenhardt R. Body temperature regulation and anesthesia[J]. Handb Clin Neurol, 2018, 157: 635-644. [13] Joris J, Ozaki M, Sessler DI, et al. Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia[J]. Anesthesiology, 1994, 80: 268-277. doi: 10.1097/00000542-199402000-00006 [14] Sessler DI. Perioperative temperature monitoring[J]. Anesthesiology, 2021, 134: 111-118. doi: 10.1097/ALN.0000000000003481 [15] Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial[J]. JAMA, 1997, 277: 1127-1134. doi: 10.1001/jama.1997.03540380041029 [16] Bindu B, Bindra A, Rath G. Temperature management under general anesthesia: Compulsion or option[J]. J Anaesthesiol Clin Pharmacol, 2017, 33: 306-316. doi: 10.4103/joacp.JOACP_334_16 [17] Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group[J]. N Engl J Med, 1996, 334: 1209-1215. doi: 10.1056/NEJM199605093341901 [18] Balki I, Khan JS, Staibano P, et al. Effect of perioperative active body surface warming systems on analgesic and clinical outcomes: a systematic review and meta-analysis of randomized controlled trials[J]. Anesth Analg, 2020, 131: 1430-1443. doi: 10.1213/ANE.0000000000005145 [19] Sessler DI, Pei L, Li K, et al. Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicentre, parallel group, superiority trial[J]. Lancet, 2022, 399: 1799-1808. doi: 10.1016/S0140-6736(22)00560-8 [20] Pasquier M, Paal P, Kosinski S, et al. Esophageal temperature measurement[J]. N Engl J Med, 2020, 383: e93. doi: 10.1056/NEJMvcm1900481 [21] Wang M, Singh A, Qureshi H, et al. Optimal depth for nasopharyngeal temperature probe positioning[J]. Anesth Analg, 2016, 122: 1434-1438. doi: 10.1213/ANE.0000000000001213 [22] Pei L, Huang Y, Mao G, et al. Axillary Temperature, as Recorded by the iThermonitor WT701, Well Represents Core Temperature in Adults Having Noncardiac Surgery[J]. Anesth Analg, 2018, 126: 833-838. doi: 10.1213/ANE.0000000000002706 [23] Thapa HP, Kerton AJ, Peyton PJ. Comparison of the EasyWarm® self-heating blanket with the Cocoon forced-air warming blanket in preventing intraoperative hypothermia[J]. Anaesth Intensive Care, 2019, 47: 169-174. doi: 10.1177/0310057X19840264 [24] Min SH, Yoon S, Yoon SH, et al. Randomised trial comparing forced-air warming to the upper or lower body to prevent hypothermia during thoracoscopic surgery in the lateral decubitus position[J]. Br J Anaesth, 2018, 120: 555-562. doi: 10.1016/j.bja.2017.11.091 [25] Cobb B, Cho Y, Hilton G, et al. Active warming utilizing combined Ⅳ fluid and forced-air warming decreases hypothermia and improves maternal comfort during cesarean delivery: a randomized control trial[J]. Anesth Analg, 2016, 122: 1490-1497. doi: 10.1213/ANE.0000000000001181 [26] Thiel B, Mooijer BC, Kolff-Gart AS, et al. Is preoperative forced-air warming effective in the prevention of hypothermia in orthopedic surgical patients? A randomized controlled trial[J]. J Clin Anesth, 2020, 61: 109633. doi: 10.1016/j.jclinane.2019.109633 [27] Lee Y, Kim K. Optimal application of forced air warming to prevent peri-operative hypothermia during abdominal surgery: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2021, 18: 2517. doi: 10.3390/ijerph18052517 [28] Roxby D, Sobieraj-Teague M, von Wielligh J, et al. Warming blood prior to transfusion using latent heat[J]. Emerg Med Australas, 2020, 32: 604-610. doi: 10.1111/1742-6723.13471 [29] Wittenborn J, Mathei D, van Waesberghe J, et al. The effect of warm and humidified gas insufflation in gynecolo-gical laparoscopy on maintenance of body temperature: a prospective randomized controlled multi-arm trial[J]. Arch Gynecol Obstet, 2022, 306: 753-767. doi: 10.1007/s00404-022-06499-z [30] Shaw CA, Steelman VM, DeBerg J, et al. Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: a systematic review and meta-analysis of randomized controlled trials[J]. J Clin Anesth, 2017, 38: 93-104. doi: 10.1016/j.jclinane.2017.01.005 [31] Kim HY, Lee KC, Lee MJ, et al. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia[J]. Korean J Anesthesiol, 2014, 66: 352-357. doi: 10.4097/kjae.2014.66.5.352 [32] Yasar PO, Uzumcugil F, Pamuk AG, et al. Comparison of combined forced-air warming and circulating-water-mattress and forced-air warming alone in patients undergoing open abdominal surgery in lithotomy position: a randomized controlled trial[J]. Indian J Surg, 2022, 84: 72-78. doi: 10.1007/s12262-021-02829-8 [33] Soysal GE, Ilçe A, Erkol MH. Effect of "an innovative technology" active warming and passive warming on unplanned hypothermia during perioperative period: a clinical trial[J]. Ther Hypothermia Temp Manag, 2018, 8: 216-224. doi: 10.1089/ther.2017.0048 [34] Cao J, Sheng X, Ding Y, et al. Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: a meta-analysis[J]. Asian J Urol, 2019, 6: 183-191. doi: 10.1016/j.ajur.2018.07.001 [35] Oderda M, Cerutti E, Gontero P, et al. The impact of warmed and humidified CO(2) insufflation during robotic radical prostatectomy: results of a randomized controlled trial[J]. Urologia, 2019, 86: 130-140. doi: 10.1177/0391560319834837 [36] Jiang R, Sun Y, Wang H, et al. Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients: a randomized controlled trial[J]. Medicine (Baltimore), 2019, 98: e17520. doi: 10.1097/MD.0000000000017520 [37] Pei L, Huang Y, Xu Y, et al. Effects of ambient temperature and forced-air warming on intraoperative core temperature: a factorial randomized trial[J]. Anesthesiology, 2018, 128: 903-911. doi: 10.1097/ALN.0000000000002099 [38] National Institute for Health and Care Excellence. Hypothermia: prevention and management in adults having surgery[EB/OL]. (2016-12-14)[2023-06-03]. https://www.nice.org.uk/guidance/CG65/chapter/Recommendations#intraoperative-phase .[39] Duryea EL, Nelson DB, Wyckoff MH, et al. The impact of ambient operating room temperature on neonatal and maternal hypothermia and associated morbidities: a randomized controlled trial[J]. Am J Obstet Gynecol, 2016, 214: 505. e1-505. e7. [40] Lai LL, See MH, Rampal S, et al. Significant factors influencing inadvertent hypothermia in pediatric anesthesia[J]. J Clin Monit Comput, 2019, 33: 1105-1112. doi: 10.1007/s10877-019-00259-2 [41] Rauch S, Miller C, Bräuer A, et al. Perioperative hypothermia: a narrative review[J]. Int J Environ Res Public Health, 2021, 18: 8749. doi: 10.3390/ijerph18168749 [42] Palanisamy S, Rudingwa P, Panneerselvam S, et al. Effect of low dose phenylephrine infusion on shivering and hypothermia in patients undergoing cesarean section under spinal anesthesia: a randomized clinical trial[J]. Int J Obstet Anesth, 2022, 50: 103542. doi: 10.1016/j.ijoa.2022.103542 [43] Gupta N, Bharti SJ, Kumar V, et al. Comparative evaluation of forced air warming and infusion of amino acid-enriched solution on intraoperative hypothermia in patients undergoing head and neck cancer surgeries: a prospective randomised study[J]. Saudi J Anaesth, 2019, 13: 318-324. doi: 10.4103/sja.SJA_839_18 [44] Mizobe T, Nakajima Y, Ueno H, et al. Fructose administration increases intraoperative core temperature by augmenting both metabolic rate and the vasoconstriction threshold[J]. Anesthesiology, 2006, 104: 1124-1130. doi: 10.1097/00000542-200606000-00005 [45] Yi J, Zhan L, Lei Y, et al. Establishment and validation of a prediction equation to estimate risk of intraoperative hypothermia in patients receiving general anesthesia[J]. Sci Rep, 2017, 7: 13927. doi: 10.1038/s41598-017-12997-x [46] Dai Z, Zhang Y, Yi J, et al. Validation of a prediction model for intraoperative hypothermia in patients receiving general anesthesia[J]. Int J Clin Pract, 2022, 2022: 6806225. [47] Yoo JH, Ok SY, Kim SH, et al. Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: comparison with passive warming, a randomized controlled trial[J]. Medicine (Baltimore), 2021, 100: e25235. doi: 10.1097/MD.0000000000025235 [48] Xiong Z, Zhu J, Li Q, et al. The effectiveness of warming approaches in preventing perioperative hypothermia: systematic review and meta-analysis[J]. Int J Nurs Pract, 2022. doi: 10.1111/ijn.13100. [49] Van Duren A. Perioperative prewarming: heat transfer and physiology[J]. AORN J, 2022, 115: 407-422. doi: 10.1002/aorn.13667 [50] Connelly L, Cramer E, DeMott Q, et al. The optimal time and method for surgical prewarming: a comprehen-sive review of the literature[J]. J Perianesth Nurs, 2017, 32: 199-209. doi: 10.1016/j.jopan.2015.11.010 [51] Ni TT, Zhou ZF, He B, et al. Effects of combined warmed preoperative forced-air and warmed perioperative intravenous fluids on maternal temperature during cesarean section: a prospective, randomized, controlled clinical trial[J]. BMC Anesthesiol, 2020, 20: 48. doi: 10.1186/s12871-020-00970-7 [52] Liu J, Wang Y, Ma W. Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review[J]. Minerva Anestesiol, 2018, 84: 1393-1405. [53] Zhuo Q, Xu JB, Zhang J, et al. Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials[J]. BMC Pregnancy Childbirth, 2022, 22: 720. doi: 10.1186/s12884-022-05054-7 [54] Dendis M, Hooven K. Preventing hypothermia during cesarean birth: an integrative review[J]. MCN Am J Matern Child Nurs, 2020, 45: 102-108. doi: 10.1097/NMC.0000000000000599 [55] Sun Y, Jia LL, Yu WL, et al. The changes of intraoperative body temperature in adult liver transplantation: A retrospective study[J]. Hepatobiliary Pancreat Dis Int, 2018, 17: 496-501. doi: 10.1016/j.hbpd.2018.08.006 [56] Perlman R, Callum J, Laflamme C, et al. A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients[J]. Crit Care, 2016, 20: 107. doi: 10.1186/s13054-016-1271-z -
点击查看大图
图(1) / 表(3)
计量
- 文章访问数: 2457
- HTML全文浏览量: 169
- PDF下载量: 2222
- 被引次数: 0
