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围手术期患者低体温防治专家共识(2017)

国家麻醉专业质量控制中心中华医学会麻醉学分会

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(6): 352-358. doi: 10.3969/j.issn.1674-9081.2017.06.007
引用本文: 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(6): 352-358. doi: 10.3969/j.issn.1674-9081.2017.06.007

围手术期患者低体温防治专家共识(2017)

doi: 10.3969/j.issn.1674-9081.2017.06.007
详细信息
    通讯作者:

    黄宇光 电话:010-69152001, E-mail:garybeijing@163.com

  • 中图分类号: R614.2+5

  • 图  1  围手术期患者低体温评估和防治操作流程

    表  1  围手术期低体温的危险因素[4-8]

    因素 具体描述
    患者因素
      年龄 年龄>60岁的患者低体温发生率更高,体温恢复时间也更长;婴幼儿,尤其是早产和低体重患儿更易发生低体温
      BMI 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少,低体温发生率更低
      ASA分级 ASA分级Ⅱ级以上患者较Ⅰ级低体温发生率增加,且ASA分级越高,低体温发生风险越高
      基础体温 基础体温是独立高风险因素,术前体温偏低患者低体温发生风险极高
      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,患者低体温发生率越高
      手术类型 开放手术比腔镜手术更易发生低体温
      手术时间 手术时间超过2 h,低体温发生率明显增高,全麻患者尤甚
      术中冲洗 使用超过1000 ml未加温冲洗液患者低体温发生率增高
    麻醉因素
      麻醉方式 全麻较椎管内或区域麻醉低体温发生率高;联合麻醉,如全麻合并椎管内或区域麻醉较单纯全麻低体温发生率高
      麻醉时间 麻醉时间超过2 h患者低体温发生率增高
      麻醉药物 吸入性麻醉药、静脉麻醉药及麻醉性镇痛药均可显著影响体温调节中枢,导致低体温发生
      术中输液/输血 静脉输注1000 ml室温晶体液或1个单位0.5 ℃库存血,可使体温下降0.25~0.5 ℃;输入未加温液体超过1000 ml低体温发生风险增高
    环境因素
      手术间温度 增加环境温度对患者低体温的发生是保护因素,通常低于23 ℃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  2  围手术期低体温的不良结局

    不良结局 具体描述
    手术切口感染[10, 13-14, 17] 体温下降2℃时患者切口感染发生率明显增高
    心血管不良事件[11-12] 低体温可抑制窦房结功能,引起心律失常,并可增加外周血管阻力,增加心肌做功和耗氧,引起心肌缺血
    凝血功能下降[15] 低体温可减弱血小板功能,降低凝血酶活性;通过调节测定温度后的血栓弹力图监测提示,低体温导致血栓形成过程受阻,血液凝集强度减弱
    麻醉苏醒时间延长[20] 低体温可延缓麻醉药物代谢,导致患者麻醉苏醒速度减慢,苏醒时间延长
    住院时间延长[13, 19] 低体温导致患者在麻醉恢复室滞留时间延长,进入重症监护室几率增加,术后恢复缓慢,住院时间延长
    下载: 导出CSV
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  • 收稿日期:  2017-08-22
  • 刊出日期:  2017-11-30

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