Intraoperative warming therapies: a comparison of three devices.
Intraoperative warming therapies: a comparison of three devices.
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DOI：
10.1016/0952-8180(92)90064-8
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发表时间：
1992-05-01
影响因子：
6.7
通讯作者：
Sessler, D I
中科院分区：
文献类型：
--
作者：
Hynson, J M;Sessler, D I
研究目的：比较三种常用的术中加温装置的有效性。设计：一项随机、前瞻性临床试验。地点：一所大学医学中心的手术室。患者：20 名因终末期肾病接受肾移植的成年患者。干预措施：患者被分配到四个加温治疗组之一：循环水毯（40 摄氏度）、加热加湿器（40 摄氏度）、强制空气加温器（43 摄氏度，毯子覆盖）腿），或控制（无需额外加热）。所有组的静脉液体均被加热（37℃），新鲜气体流量为 5 L/min。未使用被动热湿交换器。测量和主要结果：所有组的中心温度（鼓膜热电偶）在麻醉的第一个小时内下降了约 1 摄氏度。麻醉三小时后，鼓膜温度相对于基线（诱导前）的下降在强制空气加温组中最小（-0.5℃+/-0.4℃），在循环水毯组中居中（-1.2℃+/-0.4℃），在加热加湿器组和对照组中最大（-2.0℃+/-0.5℃和-2.0℃+/-0.7℃）分别为摄氏度）。使用分布式热通量传感器测得的总皮肤热损失在强制通风保暖组中比其他组少约 35W（瓦特 = 焦耳/秒）。循环水毯背部的热量增益约为 7W，而躺在标准泡沫床垫上的患者热量损失约为 3W。 结论：仅应用于有限皮肤表面区域的强制空气加温器传递更多热量，并且在临床上比其他设备更有效（在维持中心体温方面）。无论是否采用加温疗法，在所有组中观察到的中心温度早期下降的特征与麻醉引起的体内热量重新分布的理论一致。
STUDY OBJECTIVE: To compare the effectiveness of three commonly used intraoperative warming devices.DESIGN: A randomized, prospective clinical trial.SETTING: The surgical suite of a university medical center.PATIENTS: Twenty adult patients undergoing kidney transplantation for end-stage renal disease.INTERVENTIONS: Patients were assigned to one of four warming therapy groups: circulating-water blanket (40 degrees C), heated humidifier (40 degrees C), forced-air warmer (43 degrees C, blanket covering legs), or control (no extra warming). Intravenous fluids were warmed (37 degrees C), and fresh gas flow was 5 L/min for all groups. No passive heat and moisture exchangers were used.MEASUREMENTS AND MAIN RESULTS: The central temperature (tympanic membrane thermocouple) decreased approximately 1 degree C during the first hour of anesthesia in all groups. After three hours of anesthesia, the decrease in the tympanic membrane temperature from baseline (preinduction) was least in the forced-air warmer group (-0.5 degrees C +/- 0.4 degrees C), intermediate in the circulating-water blanket group (-1.2 degrees C +/- 0.4 degrees C), and greatest in the heated humidifier and control groups (-2.0 degrees C +/- 0.5 degrees C and -2.0 degrees C +/- 0.7 degrees C, respectively). Total cutaneous heat loss measured with distributed thermal flux transducers was approximately 35W (watts = joules/sec) less in the forced-air warmer group than in the others. Heat gain across the back from the circulating-water blanket was approximately 7W versus a loss of approximately 3W in patients lying on a standard foam mattress.CONCLUSION: The forced-air warmer applied to only a limited skin surface area transferred more heat and was clinically more effective (at maintaining central body temperature) than were the other devices. The characteristic early decrease in central temperature observed in all groups regardless of warming therapy is consistent with the theory of anesthetic-induced heat redistribution within the body.