Critically ill patients after three cases of accidental hypothermia and its complications.docVIP

 PAGE \* MERGEFORMAT 8 Critically ill patients after three cases of accidental hypothermia and its complications Intraoperative hypothermia is very common, due to neglect of the body temperature monitoring, surgery can be severe low-temperature and led to a series of complications. Is now on the three cases of documented cases reported are as follows. A clinical data Example 1, female, 24 years old, left lower abdominal pain and upper abdominal pain accompanied by frequent vomiting, irritability 8 h, in order to “left tubal pregnancy rupture, hemorrhagic shock,” intended to anesthesia emergency laparotomy. Burglary, when the patient unconscious, blood pressure could not be determined, HR110 times / min, breathing 24 times / min. Vein before induction of anesthesia, an open three, in the ECG and CVP monitoring downstream fluid resuscitation. Enter in the 30 min whole blood 400 ml, low molecular weight dextran 500 ml, balanced salt solution 2 000 ml, 5% sodium bicarbonate 250 ml of blood pressure after rising to 8/5.3 kPa. Using ketamine 50 mg, forskolin 60 mg, fentanyl 0.1 mg intravenous induction and tracheal intubation, followed by 1% procaine and 0.1% intravenous infusion of succinylcholine, anesthesia was maintained. Before skin incision BP 11 / 8 kPa, HR 180 times / min. Operation lasted 1.5 h, blood infusion volume 7 900 ml. Operation of fibrinogen 200 mg, Potassium 2.5 g, calcium gluconate 3.0 g. Urine 1 300 ml. 30 min after cessation of anesthesia awareness in patients did not recover, double-pupil dilated, the light unresponsive. Normal blood gas, serum potassium 37.5 mmol / L, sodium 1 428.0 mmol / L, HCT 30%, rectal temperature 30.2 ℃. Operation at room temperature 18 ~ 20 ℃, enter the banked blood temperature 4 ℃, the liquid temperature of 18 ℃. The air-conditioned room temperature and patients to improve the physical body temperature, 2 h after operation in patients with elevated body temperature reached 32.5 ℃, consciousn