充氣升溫毯維持圍手術期核心體溫有效性的系統評價_《中國循證醫學雜志》

作者：

胡云 , 宣燕 ,  王江 , 鄭宏

新疆醫科大學附屬第一附屬醫院麻醉科（烏魯木齊 110001）;

關鍵詞：

充氣升溫毯核心體溫低體溫 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130171

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目的　系統評價充氣升溫毯維持患者圍手術期核心體溫的有效性，為圍手術期選擇合適的保溫方法提供臨床依據。
方法　計算機檢索PubMed、The Cochrane Library、EMbase、Web of Science、CBM、CNKI數據庫，全面收集不同保溫方法維持圍手術期核心體溫有效性的隨機對照試驗（RCT），檢索時限均為2000～2012年，并追溯納入研究的參考文獻。由兩位研究者按照納入與排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　納入11個RCT，共577例患者。Meta分析結果顯示：在維持圍手術期核心體溫方面，充氣升溫毯加溫組分別優于電熱毯/墊組［SMD= –0.40，95%CI (–0.73，–0.06）］、循環水溫毯組［SMD= –1.10，95%CI（–1.55，–0.66）］和紅外線輻射加溫組［SMD= –0.69，95%CI（–1.06，–0.32）］；在圍手術期低體溫發生率方面，充氣升溫毯組低于電熱毯/墊加溫組［RR=1.76，95%CI（1.15，2.69）］，而與紅外線輻射加溫組相當［RR=1.37，95%CI（0.83，2.27）］；在圍手術期寒戰發生率方面，充氣升溫毯加溫組與電熱毯/墊組［RR=0.75，95%CI（0.18，3.21）］和紅外線輻射加溫組相當［RR=0.8，95%CI(0.19，3.36）］。
結論　充氣升溫毯與電熱毯/墊、紅外線輻射、循環水溫毯相比，能夠更好地維持圍手術期患者核心體溫，患者低體溫發生率更低。受納入研究數量和質量所限，上述結論尚需開展更多大樣本高質量RCT加以驗證。

引用本文： 胡云,宣燕,王江,鄭宏. 充氣升溫毯維持圍手術期核心體溫有效性的系統評價. 中國循證醫學雜志, 2013, 13(8): 985-991. doi: 10.7507/1672-2531.20130171 復制

1.	Frank SM, Shir Y, Raja SN, et al. Core hypothermia and skin-surface temperature gradients. Epidural versus general anesthesia and the effects of age. Anesthesiology, 1994, 80(3): 502-508.
2.	Sajid MS, Shakir AJ, Khatri K, et al. The role of perioperative warming in surgery: a systematic review. Sao Paulo Med J, 2009, 127(4): 231-237.
3.	Negishi C, Hasegawa K, Mukai S, et al. Resistive-Heating and Forced-Air Warming Are Comparably Effective. Anesth Analg, 2003, 96(6): 1683-1687.
4.	Leung KK, Lai A, Wu A. A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia, 2007, 62(6): 605-608.
5.	壽紅艷, 徐旭仲, 張旭彤. 不同保溫措施預防老年人全麻后低體溫的效果比較. 浙江醫學, 2005, 27(2): 126-128.
6.	Fanelli A, Danelli G, Ghisi D, et al. The Efficacy of a Resistive Heating Under-Patient Blanket Versus a Forced-Air Warming System: A Randomized Controlled Trial. Anesth Analg, 2009, 108(1): 199-201.
7.	Ng V, Lai A, Ho V. Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement. Anaesthesia, 2011, 113(5): 1076-1081.
8.	Hasegawa K, Negishi C, Nakagawa F, et al. Core temperatures during major abdominal surgery in patients warmed with new circulating-water garment, forced-air warming, or carbon-fiber resistive-heating system. J Anesth, 2012, 26(2): 168-173.
9.	Brandt S, Oguz R, Hüttner H, et al. Resistive-Polymer Versus Forced-Air Warming: Comparable Efficacy in Orthopedic Patients.Anesth Analg, 2010, 110(3): 834-838.
10.	Matsuzaki Y, Matsukawa T, Ohki K, et al. Warming by resistive heating maintains perioperative normothermia as well as forced air heating. Br J Anaesth, 2003, 90(5): 689-691.
11.	Egan C, Bernstein E, Reddy D, et al. A Randomized Comparison of Intraoperative PerfecTemp and Forced-Air Warming During Open Abdominal Surgery. Anesth Analg, 2011, 113(5): 1076-1081.
12.	Lee L, Leslie K, Kayak E, et al. Intraoperative patient warming using radiant warming or forced air warming during long operations. Anaesth Intensive Care, 2004, 32(3): 358-361.
13.	Torrie JJ, Yip P, Robinson E. Comparison of forced air warming and radiant heating during transurethral prostatic resection under spinal anaesthesia. Anaesth Intensive Care, 2005, 33(6): 733-738.
14.	李娜, 倪遠紅. 圍手術期低體溫對機體的影響及護理研究進展. 醫療裝備, 2011, 4: 54-56.
15.	Matsukawa T, Sessler DI, Christensen R, et al. Heat flow and distribution during epidural anesthesia. Anesthesiology, 1995, 83(5): 961-967.
16.	Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology, 1995, 82(3): 662-673.
17.	Kurz A, Sessler Dl, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N EngI J Med, 1996, 334(19): 1209-1215.
18.	Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of mortid cardiac events. A randomized clinical trial. JAMA, 1997, 277(14): 1127-1134.
19.	Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology, 1997, 87(6): 1318-1323.
20.	Carli F, Clark MM, Woollen JW. Investigation of the relationship between heat loss and nitrogen excretion in elderly patients undergoing major abdominal surgery under general anaesthetic. Br J Anaesth, 1982, 54(10): 1023-1029.
21.	Just B, Trévien V, Delva E, et al. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology, 1993, 79(2): 214-218.
22.	Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
23.	Dhar P. Managing perioperative hypothermia. J Anesth, 2000, 14(2): 91-97.
24.	Yoo HS, Park SW, Yi JW, et al. The Effect of Forced-Air Warming During Arthroscopic Shoulder Surgery With General Anesthesia.Arthroscopy, 2009, 25(5): 510-514.
25.	Taguchi A, Ratnaraj J, Kabon B, et al. A Effects of a circulating-water garment and forced-air warming on body heat content and core temperature. Anaesthesiology, 2004, 100(5): 1058-1064.
26.	Bergersen TK. A search for arteritivcnous anastomoses in human skin using ultrasound Doppler. Acta Physiol Scand, 1993, 147(2): 195-201.
27.	Wong A, Walker S, Bradley M. Comparison of a radiant patient warming device with forced air warming. Anaesth Intensive Care, 2004, 32(1): 93-99.
28.	向承紅, 衡陽, 劉均娥. 主動加溫在在全身麻醉胸腹部手術中保溫效果研究. 護理研究, 2008, 22(2): 425-426.

1. Frank SM, Shir Y, Raja SN, et al. Core hypothermia and skin-surface temperature gradients. Epidural versus general anesthesia and the effects of age. Anesthesiology, 1994, 80(3): 502-508.
2. Sajid MS, Shakir AJ, Khatri K, et al. The role of perioperative warming in surgery: a systematic review. Sao Paulo Med J, 2009, 127(4): 231-237.
3. Negishi C, Hasegawa K, Mukai S, et al. Resistive-Heating and Forced-Air Warming Are Comparably Effective. Anesth Analg, 2003, 96(6): 1683-1687.
4. Leung KK, Lai A, Wu A. A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia, 2007, 62(6): 605-608.
5. 壽紅艷, 徐旭仲, 張旭彤. 不同保溫措施預防老年人全麻后低體溫的效果比較. 浙江醫學, 2005, 27(2): 126-128.
6. Fanelli A, Danelli G, Ghisi D, et al. The Efficacy of a Resistive Heating Under-Patient Blanket Versus a Forced-Air Warming System: A Randomized Controlled Trial. Anesth Analg, 2009, 108(1): 199-201.
7. Ng V, Lai A, Ho V. Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement. Anaesthesia, 2011, 113(5): 1076-1081.
8. Hasegawa K, Negishi C, Nakagawa F, et al. Core temperatures during major abdominal surgery in patients warmed with new circulating-water garment, forced-air warming, or carbon-fiber resistive-heating system. J Anesth, 2012, 26(2): 168-173.
9. Brandt S, Oguz R, Hüttner H, et al. Resistive-Polymer Versus Forced-Air Warming: Comparable Efficacy in Orthopedic Patients.Anesth Analg, 2010, 110(3): 834-838.
10. Matsuzaki Y, Matsukawa T, Ohki K, et al. Warming by resistive heating maintains perioperative normothermia as well as forced air heating. Br J Anaesth, 2003, 90(5): 689-691.
11. Egan C, Bernstein E, Reddy D, et al. A Randomized Comparison of Intraoperative PerfecTemp and Forced-Air Warming During Open Abdominal Surgery. Anesth Analg, 2011, 113(5): 1076-1081.
12. Lee L, Leslie K, Kayak E, et al. Intraoperative patient warming using radiant warming or forced air warming during long operations. Anaesth Intensive Care, 2004, 32(3): 358-361.
13. Torrie JJ, Yip P, Robinson E. Comparison of forced air warming and radiant heating during transurethral prostatic resection under spinal anaesthesia. Anaesth Intensive Care, 2005, 33(6): 733-738.
14. 李娜, 倪遠紅. 圍手術期低體溫對機體的影響及護理研究進展. 醫療裝備, 2011, 4: 54-56.
15. Matsukawa T, Sessler DI, Christensen R, et al. Heat flow and distribution during epidural anesthesia. Anesthesiology, 1995, 83(5): 961-967.
16. Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology, 1995, 82(3): 662-673.
17. Kurz A, Sessler Dl, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N EngI J Med, 1996, 334(19): 1209-1215.
18. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of mortid cardiac events. A randomized clinical trial. JAMA, 1997, 277(14): 1127-1134.
19. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology, 1997, 87(6): 1318-1323.
20. Carli F, Clark MM, Woollen JW. Investigation of the relationship between heat loss and nitrogen excretion in elderly patients undergoing major abdominal surgery under general anaesthetic. Br J Anaesth, 1982, 54(10): 1023-1029.
21. Just B, Trévien V, Delva E, et al. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology, 1993, 79(2): 214-218.
22. Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
23. Dhar P. Managing perioperative hypothermia. J Anesth, 2000, 14(2): 91-97.
24. Yoo HS, Park SW, Yi JW, et al. The Effect of Forced-Air Warming During Arthroscopic Shoulder Surgery With General Anesthesia.Arthroscopy, 2009, 25(5): 510-514.
25. Taguchi A, Ratnaraj J, Kabon B, et al. A Effects of a circulating-water garment and forced-air warming on body heat content and core temperature. Anaesthesiology, 2004, 100(5): 1058-1064.
26. Bergersen TK. A search for arteritivcnous anastomoses in human skin using ultrasound Doppler. Acta Physiol Scand, 1993, 147(2): 195-201.
27. Wong A, Walker S, Bradley M. Comparison of a radiant patient warming device with forced air warming. Anaesth Intensive Care, 2004, 32(1): 93-99.
28. 向承紅, 衡陽, 劉均娥. 主動加溫在在全身麻醉胸腹部手術中保溫效果研究. 護理研究, 2008, 22(2): 425-426.

《中國循證醫學雜志》

充氣升溫毯維持圍手術期核心體溫有效性的系統評價

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《中國循證醫學雜志》

充氣升溫毯維持圍手術期核心體溫有效性的系統評價

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