充气温控毯用于神经外科手术患者的控温效果

Thermoregulatory effect of forced-air warming/cooling blanket in patients undergoing neurosurgery

目的评价充气温控毯用于神经外科手术患者的控温效果。方法40例择期行平卧位脑肿瘤切除术患者,年龄16—65岁,体重41-72 kg,ASAⅠ-Ⅲ级,随机分为2组(n=20):A组,术中充气温控毯24℃风档进行降温,肿瘤切除完毕前30 min进行复温;B组,术中充气温控毯维持中心温度正常(35．2—36．60℃)。均采用气管内静吸复合麻醉,静脉注射异丙酚1．5～2 mg／kg、芬太尼4-6μg／kg、维库溴铵0．1～0．2 mg／kg诱导,吸入0．6％-1．2％异氟醚维持;吸入氧浓度40％;异丙酚1．5～2 mg·kg-1·h-1持续输注;维库溴铵1～2 mg间断静脉注射。每5分钟记录1次中心温度(鼻咽温),观察围术期不良反应及并发症。结果A组2例患者因手术时间超过24 h剔除,共38例进行统计。A组患者降温速率(1．11±0．05)℃／h,复温速率(0．74±0．09)℃／h。A组患者89％(16/18)在硬脑膜打开前达到目标温度34℃,平台期平均中心温度(34．3±0．5)℃,距34℃最大升幅0．52℃,最大降幅为0．23℃。A组患者67％(12／18)手术结束时中心温度恢复正常。返回ICU后A组患者中心温度(返回ICU时实测温度的均值)(35．8±0．6)℃低于B组(36．6±0．4)℃(P<0．05)。A组患者4例术后出现寒颤、3例发热、1例死亡。结论神经外科手术中应用充气温控毯可较理想地降低体温,相对于降温效率其复温效率偏低。

Objective To evaluate the thermo-regulatory effect of forced-air warming/cooling blanket in patients undergoing intracranial tumor resection and the safety of mild hypothermia of 34.0℃. Methods Forty ASAⅠ-Ⅲ patients （19 male, 21 female） aged 16-65 yrs weighing 47-72 kg undergoing intracranial tumor resection were studied. Anesthesia was induced with propofol 1.5-2.0mg·kg^-1, fentanyl 4-6 μg·kg^-1 and veeuronium 0.1 mg·kg^-1 and maintained with 0.6-1.2 MAC isoflurane and continuous infusion of propofol 1.5-2 mg·kg^- 1·h^-1 ） and intermittent Ⅳ boluses of vecuronium after tracheal intubation. The patients were mechanically ventilated. Naso-pharyngeal temperature was continuous monitored as core temperature. Radial artery and right subclavian vein were cannulated for BP and CVP monitoring. The patients were randomly divided into 2 group （ n=20 each）. In group A the forced-air warming/cooling blanket was set to deliver 24℃ air to achieve a target core temperature of 34℃ by the time when dura was opened and rewarming process was started by setting the forced-air warming cooling blanket to 43℃ at about 30 min before tumor was to be removed. In group B the forced-air warmingCcoollng blanket was used to maintain a normal core temperature of 36.3-36.7℃. Adverse effects including shivering, postoperative hyperthermia 〉 38℃, arrhythmia and bradyeardia were recorded. Results The two groups were comparable with respect to demographic data, duration of anesthesia and operation and the total amount of fluid infused. Two patients were excluded from result analysis because the duration exceeded 24 h. In group A the rate of coding was （ 1.11± 0.05 ）℃ ·h^-1 and the rate of rewarming （0.74 ± 0.09）℃·h^- 1. The mean core temperature during plateau period of temperature was （34.3±0.5 ） ℃ . The maximum deviation from34℃ was 0.52℃ and the minimum 0.23℃. On arrival in ICU the core temperature of the patients in group A was significantly lower （35.8 ± 0.6℃ ） than that in group B （36.6 ± 0.4℃ ）. In group A 4 patients had shivering, 3 patients had fever and 1 patient died, while in group B no patient had shivering and fever. Conclusion Forced-air warmingCcooling blanket can be used to induce mild hypothermia （34℃） safely and conveniently during neurosurgery. Cooling is faster than rewarming.