长时程手术围术期体温保护对机体的影响
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v3i1.3944
Abstract
目的：简述低温对长时程手术的影响及变温毯在术中的保护作用。方法：查阅近年来有关术中低体温及变温毯在手术中的应用及相关影响的文献,并总结分析。结果：在长时程手术中,意外低体温的发生率较高,术中应用充气式变温毯可使IL-6、TNF-α、CRP等炎症因子降低、CD3+及CD4+、CD4+/CD8+等免疫因子升高,并显著改善低体温所致的凝血功能异常,同时围术期联合其他保温措施能够得到良好的保温效果,减少低体温的发生率。结论：术中有效的体温保护可以减轻炎症及应激反应的发生,降低机体免疫防御抑制程度,减少出血量和对输血的需求,对围手术期的体温保护提供了依据。
Keywords
低体温；变温毯；体温保护；炎症；凝血；免疫
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[2] Seamon MJ,Wobb J, Gaughan JP, et al.The effects of intraoperative hyp othermia on surgical site infection:an analysis of 524trauma laparotoomies [J].Ann Surg,2012,255:789-795.
[3] Doufas AG.Consequences of inad vertent. Perioperativehypothermia [J].Best Pract Res Clin Anaesthesiol,2003,17(4):535-549.
[4] Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting[J].J Peri Anesthesia Nurs 2001;16:187-94.
[5] Torossian A, Van Gerven E, Geer tsen K, et al. Active perioperative pat ient warming using a self-warming bl anket (BARRIER EasyWarm) is superior to passive thermal insulation: a multina tional, multicenter, randomized trial [J].J Clin Anesth 2016;34:547-54.
[6] John M, Crook D, Dasari K, et al. Comparison of resistive heating and forced-air warming to prevent inadve rtent perioperative hypothermia[J].Br J Anaesth 2016;116:249-54.
[7] Frank S, Tran K, Fleisher L, et al. Clinical importance of body temperat ure in the surgical patient [J].J Therm Biol 2000;25:151-5.
[8] Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypoth ermia[J].Best Pract Res Clin Anaesthes iol 2008;22:645-57.
[9] Jing YM. Advances in the etiol ogy and preventive measures of intra -operative hypothermia. [Article in Chinese][J].Guide China Med 2013,1134:63-5.
[10] 范满祥,叶玮,徐小英,等.综合保温措施对肠癌手术患者术后切口感染发生的影响[J].中华医院感染学杂志,2013,23:1054-1055.
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[12] 万爱玲,步爱兰,吕敏.围手术期患者低体温的原因分析及护理对策[J].齐鲁护理杂志,2004,(12):4.
[13] Zhang R,Chen XL,Xiao Y. The effects of a forced-air warming system plus electric blanket for elderly pati ents undergoing transurethral resecti on of the prostate:A randomized contro lled trial[J].Medicine 2018:97(45):e13119.
[14] Shao L,Pang NN,Yan P,et al.Cont rol of body temperature and immune function in patients undergoing open surgery for gastric cancer[J].Bosnian journal of basic medical sciences 2018,01;18(3):289-296.
[15] Kurebayashi Y,Baba Y,Minowa A, et al.TGF-β-induced phosphorylation of Akt and Foxo transcription factors negatively regulates induced regulatory T celldifferentiation[J].Biochem Biophys Res Commun,2016,480(1):114-119.
[16] Shi J, Dai W, Kloner RA.Therape utic hypothermia reduces the inflamm atory response following ischemia/repe rfusion injury in rat hearts[J].Ther Hypothermia Temp Manag,2017 Mar 24.
[17] Yang L, Roh YS, Song J, et al.Transforming growth factor beta signaling in hepatocytes participates in steatohepatitis through regulation of cell death and lipid metabolism in mice[J].Hepatology,2014,59(2):483-495.
[18] Chen Q, Fisher DT ,Clancy KA,et al.Fever-range thermal stress promotes lymphocyte trafficking across high endothelial venules via an interleukin 6 trans-signalingmechanism[J].Nature Immunology,2006,7:1299-1308.
[19] Popa C, Netea MG, van Riel PL, et al. The role of TNF-alpha in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk[J]. Journal of Lipid Research ,2007,48:751 -762.
[20] Savchenko A, Imamura M, Ohashi R, et al.Expression of pentraxin 3 (PTX3) in human atherosclerotic lesions[J].J Pathol,2008,215(1):48-55.
[21] Nebuloni M,Pasqualini F, Zerbi P, et al.PTX3 expression in theheart tissues of patients with myocardial infarction and infectiousmyocarditis [J].Cardiovasc Pathol,2011,20(1):27-35.
[22] Yuki U,Yoshiyuki F,Yuji S,et al. Condition mimicking peritoneal metas tasis associated with preoperative stag ing laparoscopy in advanced gastriccancer[J].Asian Journal of Endoscopic Surgery,2019,12(4):457-460.
[23] Caleb H,Vikas O,Dilip V,et al. Calculation of a clinical predictive factors identifying peritoneal disease on a staging laparoscopy in gastric cancers[J].South Asian Journal of Can cer,2019,8(3):166-167.
[24] Dickson C. Heat stress response and inflammation in acute temperature stresses[J].University of Ottawa, Canada, 2008.
[25] Meybohm P, Gruenewald M, Zac harowski KD, et al. Mild hypothermia alone or in combination with anesthetic post-conditioning reduces expression of inflammatory cytokines in the cer ebral cortex of pigs after cardiopulm onary resuscitation[J]. Crit Care 2010;14:R21.
[26] Halide A,Tuncer S,Yavuz D,et al.Effects of Inadvertent Perioperative Hypothermia on Metabolic and Inflam matory Mediators[J].Turkish journal of anaesthesiology and reanimation,2019,47(6):448-455.
[27] 刘凤芹,冯鸽,梁改红.凝胶啫喱垫联合水循环式变温毯保温干预对老年超低位直肠癌患者的影响[J].齐鲁护理杂志,2021,27(04):57-59.
[28] 郑鑫,孙东,周峰,等.围术期体温保护对行垂直半喉切除手术患者体温和末梢循环及出凝血时间影响[J].临床耳鼻咽喉头颈外科杂志,2017,31(14):1113- 1115.
[29] 武艳华.手术室保温措施对先天性心脏病患儿术后凝血及纤溶的影响[J].西藏医药,2020,41(04):129-130.
[30] 邱带妹,纪浩聪,彭莉利,等.术中保温对直肠癌手术患者麻醉恢复期的影响[J].广东医学,2010,31(8):1030-1031.
[31] 田文玲.腹腔镜胆囊切除术与开腹胆囊切除术对机体应激及免疫功能的影响[J].山东医药,2015,55(29):74-75.
[32] 胡翠云,王艳辉,赵江,等.围术期多元化体温保护策略对老年结直肠癌开腹手术患者免疫功能的影响[J].中外医学研究,2020,18(25):164-167.
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