Evaliation of Intraoperative Deliberate Mild Hypothermia during Neurosurgery

动物实验表明，在全脑缺血和局灶性脑缺血模型中，轻度低温(降温2-4ﾟ℃)与组织学损伤的显著减少有关。因此，我们对130名使用水毯和对流装置毯进行颅脑手术的患者进行了故意亚低温诱导。麻醉维持使用氧气、芬太尼和七氟醚中的一氧化二氮。亚低温时鼓膜测得的最低温度调整为34.5ﾟC。降温和复温的速率为1.3sy+-。[)0.8ﾟC/h和0.8(]sy.+-.[)0.3ﾟC/h。冷却速度主要与重量与表面积之比有关。术后有30%的患者观察到寒战，寒战的发生与年龄、体重、麻醉苏醒时的核心和周围温度有关。术中输注前列腺素E_1 0.02和0.05µg/kg/h对核心体温变化无影响，但0.05µg/kg/h前列腺素E_1可增加直肠温度复温。与常温相比，术中亚低温对术后伤口感染的发生及出院时间无明显影响。

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.