Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization
Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization
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DOI：
10.1056/nejm199605093341901
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发表时间：
1996-05-09
影响因子：
158.5
通讯作者：
Lenhardt, R
中科院分区：
文献类型：
--
作者：
Kurz, A;Sessler, DI;Lenhardt, R
背景资料。围手术期的轻度体温过低在大手术中很常见，它可能会引发体温调节性血管收缩，从而降低皮下氧分压，从而促进手术伤口感染。组织中氧气水平的降低会削弱中性粒细胞的氧化杀伤作用，并通过减少胶原的沉积来降低愈合伤口的强度，低温还会直接损害免疫功能。我们验证了这样一种假设，即体温过低既增加了手术伤口感染的易感性，又延长了住院时间。200名接受结直肠手术的患者被随机分配到常规术中温热护理(亚低温组)或额外加温(常温组)。患者麻醉护理规范，均给予头孢芒多和甲硝唑治疗。在双盲方案中，每天对他们的伤口进行评估，直到两周后出院和在诊所；含有培养阳性脓液的伤口被认为是感染。患者的外科医生仍然不知道患者的分组。术中平均(+/-SD)核心温度亚低温组为34.7+/-0.6℃，常温组为36.6+/-0.5℃(P
Background. Mild perioperative hypothermia, which is common during major surgery, may promote surgical-wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen, Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization.Methods. Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patients' anesthetic care was standardized, and they were all given cefamandole and metronidazole. in a double-blind protocol, their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; wounds containing culture-positive pus were considered infected. The patients' surgeons remained unaware of the patients' group assignments.Results. The mean (+/-SD) final intraoperative core temperature was 34.7+/-0.6 degrees C in the hypothermia group and 36.6+/-0.5 degrees C in the normothermia group (P