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围术期患者低体温防治专家共识(2023版)

国家麻醉专业质量控制中心

国家麻醉专业质量控制中心. 围术期患者低体温防治专家共识(2023版)[J]. 协和医学杂志, 2023, 14(4): 734-743. doi: 10.12290/xhyxzz.2023-0266
引用本文: 国家麻醉专业质量控制中心. 围术期患者低体温防治专家共识(2023版)[J]. 协和医学杂志, 2023, 14(4): 734-743. doi: 10.12290/xhyxzz.2023-0266
National Center for Quality Assurance of Anesthesia. 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 734-743. doi: 10.12290/xhyxzz.2023-0266
Citation: National Center for Quality Assurance of Anesthesia. 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 734-743. doi: 10.12290/xhyxzz.2023-0266

围术期患者低体温防治专家共识(2023版)

doi: 10.12290/xhyxzz.2023-0266
基金项目: 

中央高水平医院临床科研专项 2022-PUMCH-B-006

中央高水平医院临床科研专项 2022-PUMCH-C-011

首都卫生发展科研专项 2018-2-4013

详细信息

    通信作者: 黄宇光, E-mail: garybeijing@163.com

  • 中图分类号: R614.2+5

2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia

Funds: 

National High Level Hospital Clinical Research Funding 2022-PUMCH-B-006

National High Level Hospital Clinical Research Funding 2022-PUMCH-C-011

The Capital Health Research and Development of Special 2018-2-4013

More Information
  • 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。
    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)
  • 图  1  围术期患者低体温评估和防治操作流程

    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  2  围术期低体温不良结局

    不良结局 具体描述
    手术切口感染 体温下降2 ℃时患者手术切口感染发生率明显增高[13]
    心血管不良事件 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[14]
    凝血功能下降 低体温可减弱血小板功能,降低凝血酶活性;不同温度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 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[15]
    住院时间延长 低体温导致患者在麻醉恢复室滞留时间延长,进入重症监护室概率增加,术后恢复缓慢,住院时间延长[16]
    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
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出版历程
  • 收稿日期:  2023-06-03
  • 录用日期:  2023-07-17
  • 网络出版日期:  2023-07-24
  • 刊出日期:  2023-07-30

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