小儿患者在整形外科手术中体表暴露面积与围手术期低体温相关性的临床研究
发布时间：2018-11-03 15:27
【摘要】：研究背景:体温与血压、脉搏、呼吸、疼痛合称为人类五大生命体征。由此可见,围手术期体温的监测与管理是一个比较重要的问题,但目前在全国范围内并没有引起广泛的关注与足够的重视。尤其是小儿患者,因小儿体温调节范围较小,体温调节能力较差,围手术期更加容易出现体温降低。小儿患者.旦出现低体温,如果处理不及时或未进行适当的干预,可能会导致一系列不良事件,例如:术中出血量增多、输血需求增加、麻醉药物代谢时间延长、术后苏醒延迟、切口感染率增加、心律失常等等。由此,维持小儿患者围手术期体温在正常范围内异常重要。近年来,随着外科技术的迅猛发展,微创、腔镜类手术方式日益增多,开放性手术量较以往大幅度下降。然而,小儿患者整形外科大部分手术类型还是以传统的开放性手术为主,手术中体表暴露面积大是整形外科手术的一个重要特点。由于人体90%的热量是经由皮肤丢失的,因此,手术中体表暴露面积可能会影响麻醉医生在围手术期是否采取体温干预措施。但是,目前国内对于小儿体温方面的研究较少,更是缺乏相关的临床指南指导围手术期小儿体温的监测和管理。故此,小儿患者术中的体表暴露面积与发生低体温是否存在相关性,以及如何有效预防小儿患者围手术期低体温的发生还需要进一步探索和研究。研究目的:1、分析小儿整形外科手术中体表暴露面积与发生低体温的相关性;2、探讨可利用的体温保护措施,有效预防小儿患者围手术期低体温的发生。研究方法和结果:方法:选择择期在全身麻醉下行整形外科手术的小儿患者70例,手术室内温度控制在24℃～26℃。体表暴露面积评定是参照中国新九分法评估烧伤面积的方法,手术中体表暴露面积定义为铺单完毕后裸露的皮肤面积。围手术期低体温的确定标准是直肠温度(或鼓膜温度)低于36℃。麻醉诱导前测量患儿鼓膜温度,放置腋窝体温探头,待患儿意识消失后置入直肠温度探头,术中持续监测体温,并间隔10min记录直肠温度和腋窝温度。观察并记录麻醉时间、手术时间、停药至拔管时间,以及术中(如出血量增加)和术后(如苏醒延迟、寒战,切口感染等)不良并发症。结果:70例患儿中,18名患儿体表暴露面积达49%～8%,占25.7%,44名患儿体表暴露面积达9%～14%,占62.9%,8名患儿体表暴露面积为15%及以上,占11.4%。其中,2例患儿手术结束后发生低体温,低体温发生率为2.9%,经χ2检验,表明在整形外科手术中,小儿围手术期低体温的发生和手术中体表暴露面积没有明显相关性(χ2=19.0,P值=0.0900.05),无统计学意义。研究结论:在本研究中,当手术室温度控制在24℃～26℃时,小儿患者在整形外科手术中的体表暴露面积与围手术期低体温的发生不存在明显相关性。
[Abstract]:Background: body temperature and blood pressure, pulse, respiration and pain are five vital signs of human. It can be seen that the monitoring and management of perioperative body temperature is a relatively important issue, but at present it has not aroused widespread attention and enough attention in the whole country. Especially in pediatric patients, hypothermia is more likely to occur in perioperative period because the range of thermoregulation is small and the ability of thermoregulation is poor. Infantile patients. Hypothermia may lead to a series of adverse events, such as increased intraoperative blood loss, increased demand for blood transfusion, prolonged metabolic time of anesthetic drugs and delayed recovery after surgery, if the treatment is not timely or appropriate intervention. Incision infection rate increases, arrhythmia and so on. Therefore, it is very important to maintain perioperative body temperature in children. In recent years, with the rapid development of surgical technology, minimally invasive, endoscopic surgery is increasing, and the quantity of open operation is much lower than before. However, traditional open surgery is the main type of plastic surgery in pediatric patients. Large surface exposure area is an important feature of plastic surgery. Because 90% of the body's heat is lost through the skin, the area exposed to the body surface during the operation may affect whether the anesthesiologist takes the temperature intervention during the perioperative period. However, there are few researches on children's body temperature in China at present, and there is a lack of relevant clinical guidelines to guide the monitoring and management of children's body temperature during perioperative period. Therefore, whether there is a correlation between the exposed area of body surface and hypothermia in pediatric patients, and how to prevent hypothermia during perioperative period in children need further exploration and study. Objective: 1. To analyze the correlation between body surface exposure area and hypothermia in pediatric plastic surgery. Methods: 70 pediatric patients undergoing plastic surgery under general anesthesia were selected. The temperature in the operating room was controlled at 24 鈩，
本文编号：2308190
[Abstract]:Background: body temperature and blood pressure, pulse, respiration and pain are five vital signs of human. It can be seen that the monitoring and management of perioperative body temperature is a relatively important issue, but at present it has not aroused widespread attention and enough attention in the whole country. Especially in pediatric patients, hypothermia is more likely to occur in perioperative period because the range of thermoregulation is small and the ability of thermoregulation is poor. Infantile patients. Hypothermia may lead to a series of adverse events, such as increased intraoperative blood loss, increased demand for blood transfusion, prolonged metabolic time of anesthetic drugs and delayed recovery after surgery, if the treatment is not timely or appropriate intervention. Incision infection rate increases, arrhythmia and so on. Therefore, it is very important to maintain perioperative body temperature in children. In recent years, with the rapid development of surgical technology, minimally invasive, endoscopic surgery is increasing, and the quantity of open operation is much lower than before. However, traditional open surgery is the main type of plastic surgery in pediatric patients. Large surface exposure area is an important feature of plastic surgery. Because 90% of the body's heat is lost through the skin, the area exposed to the body surface during the operation may affect whether the anesthesiologist takes the temperature intervention during the perioperative period. However, there are few researches on children's body temperature in China at present, and there is a lack of relevant clinical guidelines to guide the monitoring and management of children's body temperature during perioperative period. Therefore, whether there is a correlation between the exposed area of body surface and hypothermia in pediatric patients, and how to prevent hypothermia during perioperative period in children need further exploration and study. Objective: 1. To analyze the correlation between body surface exposure area and hypothermia in pediatric plastic surgery. Methods: 70 pediatric patients undergoing plastic surgery under general anesthesia were selected. The temperature in the operating room was controlled at 24 鈩，
本文编号：2308190
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