【摘要】：研究背景:體溫與血壓、脈搏、呼吸、疼痛合稱為人類五大生命體征。由此可見(jiàn),圍手術(shù)期體溫的監(jiān)測(cè)與管理是一個(gè)比較重要的問(wèn)題,但目前在全國(guó)范圍內(nèi)并沒(méi)有引起廣泛的關(guān)注與足夠的重視。尤其是小兒患者,因小兒體溫調(diào)節(jié)范圍較小,體溫調(diào)節(jié)能力較差,圍手術(shù)期更加容易出現(xiàn)體溫降低。小兒患者.旦出現(xiàn)低體溫,如果處理不及時(shí)或未進(jìn)行適當(dāng)?shù)母深A(yù),可能會(huì)導(dǎo)致一系列不良事件,例如:術(shù)中出血量增多、輸血需求增加、麻醉藥物代謝時(shí)間延長(zhǎng)、術(shù)后蘇醒延遲、切口感染率增加、心律失常等等。由此,維持小兒患者圍手術(shù)期體溫在正常范圍內(nèi)異常重要。近年來(lái),隨著外科技術(shù)的迅猛發(fā)展,微創(chuàng)、腔鏡類手術(shù)方式日益增多,開(kāi)放性手術(shù)量較以往大幅度下降。然而,小兒患者整形外科大部分手術(shù)類型還是以傳統(tǒng)的開(kāi)放性手術(shù)為主,手術(shù)中體表暴露面積大是整形外科手術(shù)的一個(gè)重要特點(diǎn)。由于人體90%的熱量是經(jīng)由皮膚丟失的,因此,手術(shù)中體表暴露面積可能會(huì)影響麻醉醫(yī)生在圍手術(shù)期是否采取體溫干預(yù)措施。但是,目前國(guó)內(nèi)對(duì)于小兒體溫方面的研究較少,更是缺乏相關(guān)的臨床指南指導(dǎo)圍手術(shù)期小兒體溫的監(jiān)測(cè)和管理。故此,小兒患者術(shù)中的體表暴露面積與發(fā)生低體溫是否存在相關(guān)性,以及如何有效預(yù)防小兒患者圍手術(shù)期低體溫的發(fā)生還需要進(jìn)一步探索和研究。研究目的:1、分析小兒整形外科手術(shù)中體表暴露面積與發(fā)生低體溫的相關(guān)性;2、探討可利用的體溫保護(hù)措施,有效預(yù)防小兒患者圍手術(shù)期低體溫的發(fā)生。研究方法和結(jié)果:方法:選擇擇期在全身麻醉下行整形外科手術(shù)的小兒患者70例,手術(shù)室內(nèi)溫度控制在24℃～26℃。體表暴露面積評(píng)定是參照中國(guó)新九分法評(píng)估燒傷面積的方法,手術(shù)中體表暴露面積定義為鋪單完畢后裸露的皮膚面積。圍手術(shù)期低體溫的確定標(biāo)準(zhǔn)是直腸溫度(或鼓膜溫度)低于36℃。麻醉誘導(dǎo)前測(cè)量患兒鼓膜溫度,放置腋窩體溫探頭,待患兒意識(shí)消失后置入直腸溫度探頭,術(shù)中持續(xù)監(jiān)測(cè)體溫,并間隔10min記錄直腸溫度和腋窩溫度。觀察并記錄麻醉時(shí)間、手術(shù)時(shí)間、停藥至拔管時(shí)間,以及術(shù)中(如出血量增加)和術(shù)后(如蘇醒延遲、寒戰(zhàn),切口感染等)不良并發(fā)癥。結(jié)果:70例患兒中,18名患兒體表暴露面積達(dá)49%～8%,占25.7%,44名患兒體表暴露面積達(dá)9%～14%,占62.9%,8名患兒體表暴露面積為15%及以上,占11.4%。其中,2例患兒手術(shù)結(jié)束后發(fā)生低體溫,低體溫發(fā)生率為2.9%,經(jīng)χ2檢驗(yàn),表明在整形外科手術(shù)中,小兒圍手術(shù)期低體溫的發(fā)生和手術(shù)中體表暴露面積沒(méi)有明顯相關(guān)性(χ2=19.0,P值=0.0900.05),無(wú)統(tǒng)計(jì)學(xué)意義。研究結(jié)論:在本研究中,當(dāng)手術(shù)室溫度控制在24℃～26℃時(shí),小兒患者在整形外科手術(shù)中的體表暴露面積與圍手術(shù)期低體溫的發(fā)生不存在明顯相關(guān)性。
[Abstract]:Background: body temperature and blood pressure, pulse, respiration and pain are five vital signs of human. It can be seen that the monitoring and management of perioperative body temperature is a relatively important issue, but at present it has not aroused widespread attention and enough attention in the whole country. Especially in pediatric patients, hypothermia is more likely to occur in perioperative period because the range of thermoregulation is small and the ability of thermoregulation is poor. Infantile patients. Hypothermia may lead to a series of adverse events, such as increased intraoperative blood loss, increased demand for blood transfusion, prolonged metabolic time of anesthetic drugs and delayed recovery after surgery, if the treatment is not timely or appropriate intervention. Incision infection rate increases, arrhythmia and so on. Therefore, it is very important to maintain perioperative body temperature in children. In recent years, with the rapid development of surgical technology, minimally invasive, endoscopic surgery is increasing, and the quantity of open operation is much lower than before. However, traditional open surgery is the main type of plastic surgery in pediatric patients. Large surface exposure area is an important feature of plastic surgery. Because 90% of the body's heat is lost through the skin, the area exposed to the body surface during the operation may affect whether the anesthesiologist takes the temperature intervention during the perioperative period. However, there are few researches on children's body temperature in China at present, and there is a lack of relevant clinical guidelines to guide the monitoring and management of children's body temperature during perioperative period. Therefore, whether there is a correlation between the exposed area of body surface and hypothermia in pediatric patients, and how to prevent hypothermia during perioperative period in children need further exploration and study. Objective: 1. To analyze the correlation between body surface exposure area and hypothermia in pediatric plastic surgery. Methods: 70 pediatric patients undergoing plastic surgery under general anesthesia were selected. The temperature in the operating room was controlled at 24 鈩，

本文編號(hào)：2308190