某醫學中心腹部手術病人使用保暖設備改善術中低體溫之成效

Effectiveness of Using Warming System to Improve Intraoperative Body Temperature

10.6142/VGHN.201812_35(4).0001

黃欣誼(Hsin-Yi Huang)；蔡佩春(Pei-Chun Tsai)；戴宏達(Hung-Da Dai)；桑潁潁(Yiing-Yiing Sang)

低體溫 ； 手術全期 ； 主動加溫設備 ； hypothermia ； perioperative ； active warming system

榮總護理

35卷4期（2018 / 12 / 01）

331 - 342

繁體中文

預行手術病人於全身麻醉期間易誘發對熱的調節不良，同時合併手術室低溫環境、開放性的體腔和液體輸入量等因素，易導致非預期性手術全期低體溫，進而引發出血、心律不整和延遲術後復原，嚴重者可能導致心律不整等合併症。本研究目的為在手術過程中給予病人主動加溫設備改善術中低體溫之成效，以提供手術全期護理師維護病人體溫參考之依據。研究設計為類實驗研究，於2015年6月至2017年12月，針對腹部手術病人，分成對照組及兩組實驗組使用兩種不同充氣式主動保暖設備。納入分析共145位，包括對照組50人，實驗組一強制空氣加溫毯50人，實驗組二熱風滲透手術袍45人。結果為一、手術室內（最後一次）平均體溫實驗組一(36.19℃)和實驗組二(36.32℃)均高於對照組(35.86℃)(p = .001)，但實驗組一與實驗組二之間無顯著差異(p = .269)。結果二、手術中前三小時體溫變化，實驗組二在入手術室2.5小時後的體溫與對照組入手術室的體溫差具顯著差異(p ＜ .05)，實驗組二之保暖效果在2.5小時後優於對照組。藉此研究提出術中給予主動加溫設備可改善腹部手術病人低體溫之發生，以提升手術病人照護品質之參考。

Background: Many factors can lead to inadequate regulation of body temperature during surgery, including general anesthesia, a low temperature environment in the operating room, open body cavities, fluid input, and other factors. Possible complications include bleeding, arrhythmia, and delayed postoperative recovery. This study compared the effectiveness of active warming devices in improving normothermia intraoperatively. Methods: The control and experimental groups were retrospectively selected using a hospital-based registry from June 1 to December 31, 2015. Two experimental groups were followed from January 1, 2016 to December 31, 2017. In total, 145 adult patients with American Society of Anesthesiologist class I-III undergoing laparoscopic or laparotomic procedures under general anesthesia were included. Patients who used warm cotton blankets (n = 50; control) were compared with those in experimental groups I (n = 50, forced air warming blankets users) and II (n = 45; forced air warming gowns users). Results: The analysis of variance results revealed that the presurgical average body temperatures of the experimental groups (experiment group I, 36.19 ± 0.58° C; experimental group II, 36.32 ± 0.6 ℃) were significantly higher than those of the control group (35.86 ± 0.61 ℃) in the operating room (p = .001). A significant difference was observed between the temperatures of the control group versus those of experiment group II after 2.5 h in the operating room (p ＜ .05). Conclusion: Providing patients with forced air warming gowns before surgical procedures and using an active forced warming system on patients intraoperatively can improve hypothermia.

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