Evaliation of Intraoperative Deliberate Mild Hypothermia during Neurosurgery

对动物的研究表明，轻度低温（2-4 ℃温度降低）与全脑和局灶性脑缺血模型中组织损伤的显著减少有关。因此，我们对130例接受颅内手术的患者使用水毯和对流装置毯进行了有意的亚低温。麻醉维持与一氧化二氮在氧气，芬太尼和七氟烷。在轻度低温期间，在鼓膜处测量的最低温度被调节至34.5 ℃。冷却和复温以1.3（±）SY. ±.的速率发生。[)0.8 0.8（±）SY. [)0.3分别为100 ℃/h。冷却速率主要与重量与表面积比有关。在30%的患者中观察到术后寒战，寒战的发生与年龄、体重以及麻醉苏醒时的核心和外周温度相关。术中输注0.02和0.05 μ g/kg/h的前列腺素E1对核心温度的变化没有影响，尽管0.05 μ g/kg/h的前列腺素E1增加了直肠温度的复温率。与正常体温相比，术中亚低温不影响术后伤口感染的发生和持续时间。

Investigations in animals have demonstrated that mild degree of hypothermia (2-4ﾟC temperature reduction) are associated with substantial decrease in histologic damage in models of both global and focal cerebral ischemia. Therefore, we induced deliberate mild hypothermia in 130 patients who underwent intracranial operation using a water blanket and a convective device blanket. Anesthesia was maintained with nitrous oxide in oxygen, fentanyl and sevoflurane. The lowest temperature measured at the tympanic membrane during mild hypothermia was adjusted to 34.5ﾟC.Cooling and rewarming occurred at a rate of 1.3(]SY.+-。[)0.8ﾟC/h and 0.8(]SY.+-。[)0.3ﾟC/h, respectively. The cooling rate was mainly related to the weight to surface area ratio. Shivering was observed postoperatively in 30% and the occurrence of shivering was associated with age, weight, and core and peripheral temperature at the emergence from anesthesia. Intraoperative infusiion of prostaglandin E1 at a dose of 0.02 and 0.05mug/kg/h did not affect the changes in core temperature, although 0.05mug/kg/h of prostaglandin E1 increased the rewarming rate of rectal temperature. Intraoperative mild hypothermia did not affect the occurrence of postoperative wound infection and duration until the discharge compared with normothermia.