围手术期低体温课件.pptVIP

围手术期低体温 凤旭东 体温调节 小儿体温及调节特点 体温调节能力强，但对冷刺激代偿能力差 体表面积大，散热多 皮肤薄，皮下脂肪少 无寒战反应 通过肌肉收缩产热差 麻醉对体温的影响—全身麻醉 麻醉对体温的影响—区域麻醉 低温的利 降低机体代谢率 对脑外伤以及心跳骤停院前急救有保护作用 围手术期低体温危害 Miller`s Anesthesia: 心脏不良事件发生率增加3倍； 手术切口感染率增加3倍； 增加手术出血和异体血输血需要量20%; 延长麻醉时间和住院时间。 麻醉状态下 * 理想体温的核心温度37℃，体腔包括重要器官和脑。 体温是一种动态平衡状态，由中枢神经系统测定并维持在设定点上。 机体的自主温度调节系统能可靠地将核心温度调整在理想温度的±0.2℃范围内。 事实上，体热的分布是不均匀的，正常情况下，核心温度比外周温度高2-4℃，核心温度相对不受外周低温区域的影响。 When we talk about measurement methods, The nasopharynx, esophagus, tympanic membrane, and pulmonary artery are the sites that most accurately represent core temperatures. Since these monitoring methods are typically unavailable during regional anesthesia procedures, to maintain data integrity the focus should be on general anesthesia techniques for this quality improvement (QI) initiative. Temperature monitoring of major regional anesthesia procedures, however, remains important in daily clinical practice. When we talk about data collection and analysis, Patient temperature data should be organized according to surgical department – in other words, data should be specified as coming from procedures such as cardiac, pediatric or orthopedic. ? For a designated patient population, the initial sample will be 20 patients per week who undergo procedures with general anesthesia that last more than 30 minutes. The first 20 patient sample will provide the first data point. ? To provide an adequate sample, this 20-patient initial sample will be repeated for a period of three months (for example, 20 patients per week for 12 weeks would yield 12 data points). At the end of the three-month period data should be analyzed to derive average end of surgery patient temperature, and the hypothermia rate, for each 20-patient data point. For the purposes of this analysis, a hypothermic patient should be defined as one having a core temperature below 36°C at the end of surgery. * 核心温度仅低于正常1.5-2.0℃的低温结直肠手术患者其手术切口培养阳性率为正常体温患者的三倍，19%对比6% 除了切口感染率增加，切口感染的低温患者住院时间平均长一周。 这些发现可能是低温通过血管收缩并损害免疫系统增