Clinical Observation On Forced-Air-Warming Blanket To Prevent Patients With Perioperative Hypothermia Undergoing Radial Gastrectomy

Objective:Temperature refers to the temperature inside the body, is one of the important vital signs of the human body. The temperature of the human body is relatively constant, constant temperature to make the body each organ system’s functional activity continued steady at higher levels, to enhance the body’s ability to adapt to the environment. By the temperature regulating system the body keeps the heat production and heat dissipation of dynamic balance, so that the stability of the core body temperature. If the body’s heat production is greater than the heat release, the temperature will rise; Heat release is greater than the heat yield temperature will drop, until to produce heat and heat to strike a balance, just can make temperature stability in the new level. Low temperature, however, become one of the important factors of endangering the safety of anesthesia surgery patients. There are many factors which lead to perioperative hypothermia:the factors of the patients themselves, the role of narcotic drugs, the influence of ambient temperature, operation, blood transfusion and infusion. Perioperative hypothermia would bring a lot of harm to the patient, it increase the recovery time of anesthesia and the bleeding, increase incidence of surgical site infection, acid-base balance disorders, breathing, circulation, the nervous system complications, postoperative increased incidence of chills, fever, and even endanger the patient lives. How to strengthen the intraoperative temperature monitoring, prevent the happening of hypothermia, is becoming a hot spot of clinical anesthesia research. Forced-air-warming blanket rely on warm blanket unique warm air layer is formed between airflow in the patient’s skin, the patient is always in a warm environment, effectively prevents the body’s total heat loss. This paper intends to observe perioperative patients with radial gastrectomy with forced-air-warming blanket to prevent hypothermia clinical effect.Methods:Collected during September2013to February2014, provincial hospital affiliated to Shandong university100cases patients with radial gastrectomy surgery, ASA Ⅰ～Ⅱ level,64males,36females, age from45to72years old, body mass index from20to25. Times of surgery were all longer than3hours. Randomly divided into heat preservation group and the control group,50cases in each group. Adjusted room temperature at26℃, and all infusion and rinse fluid keep at room temperature. After the patient into the operation rooms (TO), measure axillary temperature. After the nasopharyngeal table linen in nasopharyngeal temperature detector, nasopharyngeal temperature probe from the nasal cavity insert about10～12cm. Monitoring of the electrocardiogram (ECG) and heart rate (HR), blood pressure (BP), pulse oxygen saturation (SpO2). Establishing venous pathway, patients of two groups were given penehyclidine0.01mg·kg-1. To the heat preservation group, with forced-air-warming blanket covering the lower half. Cover a wide range of bilateral iliac spines on the attachment below, before adjusting air temperature of40℃. The control group patients are normal processing.Anesthetic procedures were identical for two groups. Patients of two groups were given midazolam0.04mg·kg-1, cisatracurium0.2mg·kg-1, etomidate0.2mg·kg-1, sufentanil0.5μg·kg-1. Mask ventilation after3minutes, did intubation, started to mechanical ventilation. Adjusting breathing machine parameters:breathing rate10-12times·min-1, tidal volume8-10ml·kg-1, suction than1:2, oxygen flow rate of2.0L·min-1, according to the CO2partial pressure (maintain between35-45mmHg) adjust the tidal volume and respiratory frequency. Two groups of patients who are at a constant speed pump into the propofol8-12mg·kg-1·h-1.10min before the end of the surgery, stop pumping the propofol infusion. Intravenously gave cisatracurium0.1mg·kg-1. Since half an hour before the end of operation, no longer gave cisatracurium. If it is necessary, give sufentanil0.1μg·kg-1. When the patient appears after swallowing or choke to cough, give neostigmine1mg. If you need blood transfusion in the operation, put the blood in the constant temperature box for15min, and then input the patient.Record the core temperature、 HR、MAP after the patient into the operating room (TO)、30min (T1)、60min (T2)、90min (T3)、120min (T4)、150min(T5)、180min (T6) after anesthesia induction and at when operation was over(T7). Record the bleeding in surgery. Record the time and whether patients had chills. Record patients with and without fever and postoperative hospitalization days, fever indexes for temperature at37.4℃or more. All data use SPSS19.0application data processing software, counting data use χ2test, measuring data using t-test. When P<0.05, we thought the significant was statistically.Results:Two groups of patients after home (TO), axillary temperature measurement no statistical difference (P>0.05). Comparison in the group, patients temperatures were significantly lower30min(T1) after anesthesia induction,(P<0.05). At the end of the surgery (T7) body temperature decreased significantly(P<0.05), heat preservation group body temperature is also a downward trend, but compared with control group, the relatively slow decline. Compared with the control group, the temperatures of heat preservation group at120min (T4)、150min (T5)、180min (T6) after anesthesia induction and at the end of the surgery (T7) has significant difference (P<0.05), they were obviously higher. Two groups of patients during anesthesia blood pressure (BP) and heart rate (HR) there was no significant difference. Heat preservation group waking time significantly shortened than the control group (P<0.05), and the bleeding in surgery significantly less than the control group (P<0.05). Compared with the heat preservation group, control group in the incidence of postoperative shivering is definitely too high (P<0.05). Heat preservation group number within three days of postoperative fever reduced generally, hospitalization days also shortened accordingly.Conclusion:The use of forced-air-warming blanket can shorten the time of the blanket, reduce the bleeding in surgery, reduce the incidence of postoperative chills and fever, shorten hospitalization time.