降低機器人二尖瓣手術病人術後低體溫發生率

Reducing the Incidence of Postoperative Hypothermia in Patients Undergoing Robotic-Assisted Mitral Valve Surgery

10.6224/JN.202308_70(4).09

黃翠文(Tsui-Wen HUANG)；陳穎珊(Ying-Shan CHEN)；翁凱貞(Kai-Jeng WENG)；林慧玲(Hui-Ling LIN)

機器人二尖瓣手術 ； 低體溫 ； 跨團隊合作 ； robotic-assisted mitral valve surgery ； hypothermia ； interprofessional collaboration

護理雜誌

70卷4期（2023 / 08 / 01）

67 - 76

繁體中文;英文

背景：手術後低體溫易產生併發症，本單位機器人二尖瓣手術病人術後至加護病房低體溫發生率為60%，致使加護病房住院天數延長，甚至有8位（57%）低體溫者發生心律不整。導因為手術室室溫太低、術後未立即執行被單覆蓋、體外心肺循環復溫時間太短、術後無熱被覆蓋病人、冷的加護病床、缺乏稽核與低體溫在職教育。目的：降低機器人二尖瓣手術病人至加護病房低體溫發生率由60%降至36%，1小時後低體溫發生率由43.3%降至26%。解決方案：藉由調升室溫、預熱加護病床、跨團隊合作增加體外心肺循環復溫時間、增加專用溫被區以利術後給予熱被及舉辦在職教育提升護理師認知等措施。結果：機器人二尖瓣手術病人至加護病房低體溫發生率由60%降至19.4%，1小時後低體溫發生率由43.3%降至19.4%。結論：藉由跨團隊合作提供組合式保溫照護措施，有效降低機器人二尖瓣手術病人術後低體溫發生率，縮短加護病房住院天數，建議可運用於手術時間長、傷口大及體表暴露面積大的手術，以提升手術全期照護品質。

Background & Problems: Post-operation hypothermia tends to induce complications. Sixty percent of robotic-assisted mitral valve surgery patients experienced hypothermia while admitted to our intensive care unit (ICU), resulting in prolonged ICU stays and 57% (eight) of those patients with hypothermia also experiencing cardiac arrhythmia. The causes of hypothermia in our ICU included low temperature in the operating room, delayed initiation of blanket coverage after surgery, and lack of postoperative thermal blankets, insufficient cardiopulmonary bypass rewarming time, cold ICU beds, lack of in-service training for hypothermia, and lack of procedure auditing. Purpose: This intervention was designed to reduce the incidence of hypothermia in ICU patients undergoing robotic-assisted mitral valve surgery upon ICU admission from 60% to 36% and the one-hour hypothermia rate from 43.3% to 26%. Resolutions: We implemented several measures including increasing the room temperature, pre-heating the ICU bed, achieving team consensus regarding prolonging the rewarming time after cardiopulmonary bypass, establishing a blanket warming area for postoperative patient use, and holding in-service training to enhance the awareness of the nurses were implemented. Result: The incidence of hypothermia in ICU patients receiving robotic-assisted mitral valve surgery upon ICU admission decreased from 60% to 19.4%, while the one-hour hypothermia rate decreased from 43.3% to 19.4%. Conclusions: Using systemic interprofessional collaboration, combined thermal care can be achieved to significantly reduce the incidence of postoperative hypothermia in patients undergoing robotic-assisted mitral valve surgeries resulting in higher patient care quality and shorter ICU stays. We recommend applying this combined method to improve the quality of perioperative care for long-duration and major surgical procedures that involve large postoperative wounds and for patients who may require wider exposure during their operation.

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