| Objective: The perioperative hypothermia a is one of the common complications of anesthesia and surgery. There are variety of reasons which lead to the drop of patients'body temperature: the role of anesthetic drugs, the effect of the environment temperature, operation, transfusion and blood transfusion, and the factors of the patients themselves. Thereinto, the suppression role of anesthesia to the temperature adjustment system is the most important reason. Low body temperature can bring many negative effects to patients, such as it prolong the recovery time of anesthesia, make patients uncomfortable, cause disfunction of coagulation system, reduce the body immunity, and it even increase the complications of the circulation and respiratory system, endanger the patient's life. In recent years, the monitoring of body temperature and keeping warm of patients have been gradually paid more attention to by clinical anesthesia and nursing staff. In this experiment, we observed the changes of patients'core temperature, these patients are treated in different insulation measures, and also observed the effect of body temperature to the anesthesia recovety time, tube drawing time and whether the patients chilled, to discusses the regular pattern, the influencing factors and the consequences of the changes of body temperature. Methods: Chose 30 cases who were operated under general anesthesia, 16 males and 14 females, age from 31 to 79 years old, weight from 44 to 77kg, the ASA classification were all levelⅡ. 19 cases of open-abdomen surgery, 4 cases of open-chest surgery and 7 cases of orthopaedic surgery. Times of surgery were all longer than 2 hours and infusion quantities were all more than 2000ml. They were randomly divided into heat preservation group and control group, each group includes 15 cases. Two groups of patients generally had no statistically significant differences. After patients entered the operation rooms, routinely monitored electrocardiogram, heart rate, blood pressure and pulse oxygen saturation, and measure axillary temperature(Te0). To the temperature preservation group, adjusted room temperature at 24°C to 26°c, all infusion (crystal and colloid) and rinse fluid are placed in the constant temperature box to be preheated to 36°C ~ 38°C. To the control group , adjusted room temperature at 21°C to 23°C , and infusion fluid at 20°C to 22°C. Patients of two groups were given midazolam 0.04 mg/kg intravenously, target control infused propofol. When the plasma concentration reach to 3.0μg/ml, gave vecuronium 0.1 mg/kg intravenously and sufentanil 0.5μg/kg. 3 minutes later, did intubation and connected to anesthesia machine, started to mechanical ventilation. After the anesthesia induction put the probe into nose-pharynx to measure core temperature. During the anesthesia maintain process, keep the propofol plasma concentrations at 4.0μg/ml continuous. Intravenously gave vecuronium 0.04mg/kg or sufentanil 0.1μg/kg when necessary . Appropriately gave drugs to maintain the circulation system stable. Record the core temperature at 30min, 60min, 120min after anesthesia induction and at the time when operation was over. If blood transfusion was needed, put the blood for preservation group and control group specially in the constant temperature box and wild environment for 15min to 20min before gave patients infusion. Since half an hour before the surgery, no longer gave muscle relaxants. Stop the propofol infusion 10min before the end of the operation. When patients can swallow or cough, gave neostigmine 1mg to antagonist residual muscle relaxants. After the operation, no longer give any sedation drugs. Observed and recorded the time from when operation was finished to patients can be called to open their eyes and the time for the endotracheal tube can be pulled out and whether patients had chills. Used SPSS17.0 application data processing software, measuring data using t-test, counting data useχ2 test. When p < 0.05, we thought the significant was statistically.Results: Temperatures of the two groups measured just after entering the operation room had no significant difference (p > 0.05). Within the group, 30min after anesthesia induction, temperatures were significantly dropped (p < 0.05). Compared with the control group, the temperatures of insulation group at 120min after anesthesia induction and at the end of the operation were obviously higher. Compared with the control group, waking time and tube-pulled-out time were significantly short (p < 0.05). The incidence of postoperative chills of control group was obviously higher than heat preservation group (p < 0.05).Conclusion: After the induction of general anesthesia, the intravenous anesthetic drugs made the core body temperature dropped rapidly. And the core temperature continued to decline during the anesthesia and surgery process. Warming transfusion , blood transfusion and regulating room temperature had notable effect on reducing the drop of patients'temperature and the happen of hypothermia. Hypothermia prolonged the drug metabolism time , and then prolong the anesthesia recovery time and the tube pulled-out time . Hypothermia increased the rate of chillness of patients after operation. The measuring of body temperature should be taken seriously, and we should taking measures to keep patients warm. |
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