麻醉对患者体温的影响

作者;曾独娟，李爱民，冯国辉，雷志礼［摘要］目的观察全身麻醉与硬膜外麻醉中体温的变化规律及低体温对麻醉中患者的影响，为加强术后体温护理提供依据。方法选择全麻开腹手术患者50例，ASAⅠ~Ⅱ级。按照随机表法随机分为两组，全麻组25例，硬膜外组25例，两组生命体征均维持稳定，室内温度维持在22 ℃~25 ℃，常规铺单外不做保温处理。观察两组术前、术中及术毕体温变化；术毕时寒颤及躁动的发生率。结果与术前比较，术中和术毕两组体温明显降低；组间比较差异有显著性；术毕完全清醒时全麻组比硬膜外组寒颤、躁动发生率高。结论麻醉后食管温度会明显下降，但全麻时下降更明显。体温降低对寒颤、躁动的发生率有影响；麻醉手术中应监测体温，注意体温的保护，以降低上述反应的发生率。［关键词］低温；麻醉；手术 Effects of anesthesia on body temperature of patients ［Abstract］ Objective To observe the effects of anesthesia (general anesthesia and epidural block) on temperature of patients and to provide the basis for strengthening care in temperature of patient.Methods ASAⅠ~Ⅱ fifty patients undergoing abdominal surgery were divided into two groups (general anesthesia Ⅱ，n=25 and epidural group Ⅰ，n=25).Group Ⅰ and group Ⅱ temperature were used to assess core temperature monitored simultaneously.The temperatures were recorded during induction (T1)，10(T2)，30(T3)，60(T4)，90(T5)，120(T6)，150(T7) min after induction and at the end of surgery (T8).Proportion of occurrence of shiver and rashness was recorded at the consciousness of the end of surgery.Result In the group Ⅱ，the core temperature started decreasing after induction，it was significantly lower since 10 min after induction than pre-induction.Core temperature kept decreasing until the end of operation.In the group Ⅰ，core temperature started decreasing 30 min after induction，the core temperatures from 30 min after induction to the end of operation were significantly lower than those of pre-induction.The core temperature decreases more rapidly in the group Ⅱ than the group Ⅰ.Conclusion Both epidural and general anesthesia cause core hypothermia，but general anesthesia results in more lower core temperature than epidural anesthesia does.Hypothermia influences on proportion of occurrence of in shiver and rashness.Body temperature will be inspected during operation.Be careful while protecting body temperature.Cut down syndrome.[!--empirenews.page--] ［Key words］ hypothermia;anesthesia;operation 围术期低体温是麻醉手术中常见并发症之一，大约50%的手术病人麻醉手术中中心体温低于36 ℃［1］，尤其是手术时间长、老年人及小儿更易发生［2］。低温在某些时候对机体可能是有益的（低温灌注时的器官保护），但多数情况下会产生不良影响。因此，维持手术中病人的正常体温是降低围术期并发症的重要措施。本研究拟观察全身麻醉与硬膜外麻醉患者的体温变化，及低温对术毕完全清醒时患者寒颤、躁动的影响，为加强体温提供依据。 1 资料与方法 1.1 一般资料 50例择期腹腔手术患者，男15例，女35例，年龄18~68岁。无代谢疾病，ASAⅠ~Ⅱ级。随机分为硬膜外组（Ⅰ组，n=25），全身麻醉组（Ⅱ组，n=25）。两组性别、年龄、体重、手术时间、出血量、输血输液量及ASA分级差异均无显著性。 1.2 方法术前禁食、清洁灌肠、肌注苯巴比妥钠和阿托品。Ⅰ组在穿刺置入硬膜外导管后，硬膜外推注2%盐酸利多卡因5 ml试验量，5 min后无局麻药中毒应及腰麻征，再注入1.5%盐酸利多卡因，阻滞平面低于第4胸椎水平，另静脉注射咪唑安定10 mg，使患者入睡。Ⅱ组麻醉诱导采用咪唑安定0.1mg/kg、依托咪酯0.3 mg/kg、芬太尼5 μg/kg、维库溴铵 0.1 mg/kg静注；异丙酚持续泵注、异氟醚吸入维持，酌情追加芬太尼和维库溴铵。两组生命体征均维持稳定，手术室内温度保持在22 ℃~25℃，常规铺单外不做保温处理。在表面麻醉下经口腔或鼻道将体温探头置入食管平心房水平处，用太空监护仪记录麻醉前（T1）、麻醉后10（T2）、30（T3）、