开腹手术中实施三种不同保温措施对病人体温变化影响的研究
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摘要
目的：探讨开腹手术中使用加温纯棉线毯、电加温毯、电加温毯与加温腹腔冲洗液复合保温等三种不同的保温措施对病人体温变化的影响。
方法：选取全麻下行开腹手术病人90例，采用便利抽样的方法，根据手术时间的先后顺序分为三组：双层纯棉线毯组采取覆盖加温至50℃线毯的方法保温；电加温毯组采取覆盖42～46℃电热毯的方法保温；复合保温组采用电加温毯和加温至37℃的腹腔冲洗液两种方法保温，每组各30例。手术中持续监测病人的直肠温度变化，记录病人入室时、麻醉后、切皮时、切皮后30分、60分、90分、120分、150分、180分及手术结束时的温度。
结果：1、线毯组中，入室温度为37.0±0.26℃，麻醉后温度为36.8±0.38℃，与入室温度相比，P=0.045＜0.05，有显著性差异；切皮时、切皮后30分及以后各时间点与入室温度相比，P值均小于0.01，有极显著性差异。加温毯组中，入室温度为36.7±0.24℃，麻醉后及其后各时间点温度与入室温度相比，均无显著性统计学差异。复合保温组入室温度为36.9±0.23℃，各时间点温度与入室温度比较的结果与加温毯组相同。2、三组温度组间比较结果显示：麻醉后各时间点组间F=0.393，P=0.676，无显著性差异；切皮时及之后各时间点间P值均小于0.01，三组间有极显著性差异；三组两两比较结果，加温毯组与复合保温组间各时间点的温度无显著性差异，而线毯组与其他两组相比，切皮时P值均＜0.05，有显著性差异，切皮后30分及其后各时间的P值均＜0.01，分别有极显著性差异。
结论：加温至50℃的双层纯棉线毯对体温变化没有影响，不能起到有效的保温作用；使用温度为42～46℃的电加温毯具有良好的保温效果，可预防病人体温的下降；单纯使用加温至37℃的腹腔冲洗液对病人体温变化没有影响，不能起到保温作用。
Purpose: To investigate the effects of three warming interventions on temperature maintenance during open abdominal surgery.
Method: Ninety patients who underwent open abdominal surgery were assigned to three groups: 30 patients in the group with warmed cotton-blanket in about 50℃, 30 patients in the group with electric warming system in about 42-46℃, and 30 patients in the group with two warming interventions which is electric warming system in about 42-46℃and warming irrigation solution in about 37℃. Rectal temperature were recorded after entering the operating room, after intubation, at incision and every 30 minutes after that, at skin closed.
Result: 1. Compared with the temperature when entering the operating room, the rectal temperature at intubation, incision and every 30 minutes after that, skin closed, were significantly lower in the warming cotton-blanket group. 2. There was the same result between the other two groups: Compared with the temperature when entering the room, there was no difference.
Conclusion: During the open abdominal surgery, warming cotton-blanket and irrigation solution cannot prevent perioperative hypothermia. Electric warming system is the most efficient in maintaining perioperative normothermia during the three interventions.
方法：选取全麻下行开腹手术病人90例，采用便利抽样的方法，根据手术时间的先后顺序分为三组：双层纯棉线毯组采取覆盖加温至50℃线毯的方法保温；电加温毯组采取覆盖42～46℃电热毯的方法保温；复合保温组采用电加温毯和加温至37℃的腹腔冲洗液两种方法保温，每组各30例。手术中持续监测病人的直肠温度变化，记录病人入室时、麻醉后、切皮时、切皮后30分、60分、90分、120分、150分、180分及手术结束时的温度。
结果：1、线毯组中，入室温度为37.0±0.26℃，麻醉后温度为36.8±0.38℃，与入室温度相比，P=0.045＜0.05，有显著性差异；切皮时、切皮后30分及以后各时间点与入室温度相比，P值均小于0.01，有极显著性差异。加温毯组中，入室温度为36.7±0.24℃，麻醉后及其后各时间点温度与入室温度相比，均无显著性统计学差异。复合保温组入室温度为36.9±0.23℃，各时间点温度与入室温度比较的结果与加温毯组相同。2、三组温度组间比较结果显示：麻醉后各时间点组间F=0.393，P=0.676，无显著性差异；切皮时及之后各时间点间P值均小于0.01，三组间有极显著性差异；三组两两比较结果，加温毯组与复合保温组间各时间点的温度无显著性差异，而线毯组与其他两组相比，切皮时P值均＜0.05，有显著性差异，切皮后30分及其后各时间的P值均＜0.01，分别有极显著性差异。
结论：加温至50℃的双层纯棉线毯对体温变化没有影响，不能起到有效的保温作用；使用温度为42～46℃的电加温毯具有良好的保温效果，可预防病人体温的下降；单纯使用加温至37℃的腹腔冲洗液对病人体温变化没有影响，不能起到保温作用。
Purpose: To investigate the effects of three warming interventions on temperature maintenance during open abdominal surgery.
Method: Ninety patients who underwent open abdominal surgery were assigned to three groups: 30 patients in the group with warmed cotton-blanket in about 50℃, 30 patients in the group with electric warming system in about 42-46℃, and 30 patients in the group with two warming interventions which is electric warming system in about 42-46℃and warming irrigation solution in about 37℃. Rectal temperature were recorded after entering the operating room, after intubation, at incision and every 30 minutes after that, at skin closed.
Result: 1. Compared with the temperature when entering the operating room, the rectal temperature at intubation, incision and every 30 minutes after that, skin closed, were significantly lower in the warming cotton-blanket group. 2. There was the same result between the other two groups: Compared with the temperature when entering the room, there was no difference.
Conclusion: During the open abdominal surgery, warming cotton-blanket and irrigation solution cannot prevent perioperative hypothermia. Electric warming system is the most efficient in maintaining perioperative normothermia during the three interventions.
引文
1. Guyton AC, Body temperature regulation and fever. In: Guyton AC, Hall JE, eds. Textbook of Medical Physiology, 9th edition. Philadelphia: W.B. S aunders. 1996: 911-22.
2. Hervey GR. Thermoregulation. In: Emslie-Smith D, Paterson C, Scratcherd T, Read N, eds. Textbook of physiology, 11th edition. Edinburgh: Churchill-Livingstone. 1988: 510-33.
3. Sessler DI. Temperature monitoring. In: Millar RD, ed. Anesthesia. New York: Churchill Livingstone. 1994:1363-82.
4．张镜如，主编．生理学．第4版．北京：人民卫生出版社．1995．
5. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997.336: 1730-1737.
6. Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology, 1993, 78: 468-75.
7．刘小颖，吴新民．围术期低体温．中华麻醉学杂志．2003．23(9)：712-4．
8. Larry M, Gentilello MD, Vicente CMD, et al. Continuous arterivenous re-warming: Experimental results and thermodynamic model simulation of treatment for hypothermia. Trauma. 1990, 1436-48.
9．刘俊杰，赵俊，主编．现代麻醉学．第2版．北京：人民卫生出版社，1996
10. Hanagata K,Matsukawa T, Sessler DI, et al. Isoflurane and sevoflurane produce a dose-dependent reduction in the shivering threshold in rabbits. Anesth Analg, 1995, 81(3):581-584.
11. Kurz A, Seeler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypother- mia. J Clin Anesth. 1995;7:359-366.
12．张淑月，朱君宇，彭延增，等．术中低体温对患者麻醉恢复期的影响及护理干预．中华护理杂志，2003，38(3)：176-8．
13. Beilin B, Shavit Y, Jacob R, et al. Effect of mild perioperative hypothermia on cellular immune responses. Anesthesiology, 1998, 89:1133.
14. Daniel I, Sessler. Complications and treatment of mild hypothermia. Anesthesiology, 2001, 95:531-543.
15．盛卓人，主编．实用临床麻醉学．第3版．沈阳：辽宁科学技术出版社，1996．
16. Valeri CR, Khabbaz K, Khuri SF, Marquardt C, Ragno G; Feinhold H, et al. Effect of skin temperature on platelet function in patients undergoing extracorporeal bypass. J Thorac Cardiovasc Surg, 1992, 104:108-116.
17. Kurz A, Sessler DI, Lenhardt RA. Study of wound infections and temperature group: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996;334:1209-1215.
18. Sessler DI. Perioperative thermoregulation and Heat balance. Ann N Y Acad Sci, 1997, 15: 813757-813777.
19. Kurz A. Intraoperative hypothermia: pathophysiology and clinical sequelae. Wien Klin Wochenschr, 1997, 109:261-269.
20. Heier T, Caldwell JE, Seeler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthsiology, 1991, 74:815-819.
21. Seeler DI, Seeler AM. Experimental determination of heat flow parameters during induction of anesthesia. Anesthesiology, 1998, 89:657-665.
22. Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Seeler DIet al. Mild intraoperative hypothermia prolongs postoperative recovery. Anesthesiology. 1997, 87: 1318-1323.
23. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001; 95(2):531-543.
24. Negishi C, Hasegawa K, Mukai S, et al. Resistive-heating and forced-air warming are comparably effective. Anesth Analg, 2003, 96(6): 1683-1687.
25．吴阶平，裘法祖，主编．黄家驷外科学(上、中、下)．第6版．北京：人民卫生出版社，2000．
26. D.J. Buggy, A.W.A. Crossley. Thermoregulation, mild peri- operative hypothermia and post-anaesthetic shivering. British Journal of Anaesthesia. 2000.84: 615-28.
27. Sessler DI. Perioperative heat balance. Anesthesiology, 2000, 92(2):578-596.
28．赵俊，主编．新编麻醉学．北京：人民军医出版社，2002．
29. Sellden E, Branstrom R, Brundin T. Preoperative infusion of amino acids prevents postoperative hypothermia. British Journal of Anaesthesia. 1996.76: 227-34.
30. Sellden E, Brundin T, Wahren J. Augmented thermic effect of amino acids under general anaesthesia: a mechanism for prevention of anaesthesia-induced hypothermia. 1994.8:611-8.
31. Sellden E, Branstrom R, Brundin T. Augmented thermic effect of amino acids under general anaesthesia occurs predominantly in extra- splanchnic tissues. 1996.91: 431-9.
32. Lindahl SG. Sensing cold and producing heat. Anesthesiology. 1997. 86: 758-9.
33. Davis, Annette J.M, Bissonnette, et al. Thermal regulation and mild intraoperative hypothermia. Current Opinion in Anaesthesiology, 1999,12(3):303-309.
34．妇科：陈淑坚,主编．妇产科护理学．第1版．北京：人民卫生出版社,1991．
35. Kim JS, Ikeda T, Sessler DI. Turakhia M, Jeffrey R. Epidural anesthesia reduces the gain and maximum intensity of shivering. Anesthesiology. 1998. 88: 851-7.
36. Kurz A, Plattner O, Sessler DI, Huemer G, Redl G, Lackner F. The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients. Anesthesiology. 1993. 79:465-9.
37. Kura A, Xiong J, Sessler DI, Dechert M, Noyes K, Belani K. Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstricition in humans. Anesthesiology. 1995. 83:1212-9.
38. Ozaki M, kurz A, Sessler DI, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology. 1994. 81:282-8.
39. Scherer R. Intraoperative heat conservation. A lot of hot air? Anaesthesist, 1997, 46:81-90.
40. Sessler DI. Olofsson CI, Rubinstein EH. The thermoregulatory threshold in humans during nitrous oxide-fentanyl anesthesia. Anesthesiology, 1988, 69:357-364.
41. Sessler DI, Olofsson CI, Rubinstein EH, Beebe JJ. The thermoregulatory threshold in humans during halothane anesthesia. Anesthesiology, 1988, 68:836-842.
42. Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng C. Propofol linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology, 1995, 82:1169-1180.
43. Xiong J, Kurz A, Sessler DI, Plattner O, Christensen R, Dechert M, Ikceda T. Isoflurane produces marked and non-linear decreases in the vasoconstriction and shivering thresholds. Anesthesiology, 1996, 85:240-245.
44. Annadata RS, Sessler DI, Tayefeh F, Kurz A, Dechert M. Desflurane slightly increases the sweating threshold, but produces marked, non-linear decreases in the vasoconstriction and shivering thresholds. Anesthesiology, 1995, 83:1205-1211.
45. Kurz A, Go JC, Sessler DI, Kaer K, Larson M, Bjorksten AR. Alfentanil slightly increases the swrating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology, 1995,83: 293-299.
46. Kurz A, Ikeda T, Sessler DI, Larson M, Bjorksten AR, Dechert M, Christensen R. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology, 1997, 86:1046-1054.
47. Toyota K, Sakura S, Saito Y, et al. The effect of pre-operative administration of midazolam on the development of intraoperative hypothermia. Anaesthesia, 2004, 59(2):116-121.
48. Young DM. Risk factors for hypothermia in psychiatric patients. Ann Clin Psychiatry, 1996, 8(2):93-97.
49. Kudoh A, Takase H, Takazawa T. Chronic treatment with antipsychotics enhances intraoperative core hypothermia. Anesth Analg, 2004, 98(1):111-115.
50. Kudoh A, Takase H, Takazawa T. Chronic treatment with antidepressants decreases intraoperative core hypothermia. Anesth Analg, 2003, 97(1):275-279.
51. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology, 2002, 96(2):467-484.
52. Morris RH, Wilkey BY. The effects of ambient temperature on patient temperature during surgery not involving body cavities. Anesthesiology. 1970;32:102-107.
53. Morris RH. Operating room temperature and the anesthetized paralyzed patient. Arch Surg. 1971;103:95-97.
54. Sahin A, Aypar U. Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering: Comparison of two anesthetic regimens. Acta Anaesthesiology Scand, 2002,46(1):64-67.
55. Reo CR Effect of bowel exposure on body temperature during surgical operations. AM J Surg, 1971,122:13-15.
56. Just B, Trevien V, Delva E, Lienhart A. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology. 1993;79:214-218.
57. Hynson Jm, Sessler DI, Moayeri A, et al. The effects of pre-induc- tion warming on temperature and blood pressure during propofol/ nitrous oxide anesthesia. Anesthesiology. 1993 ;79:219-228.
58. Nguyen NT, Fleming NW, Singh A, et al. Evaluation of core temperature during laparoscopic and open gastric bypass. Obes Surg, 2001, 11(5):570-575.
59. Kurz A, Sessler DI, Narzt E, Lenhart R. Morphometric influences on intraoperative core temperature changes. Anesth Analg. 1995; 80:562-567.
60. Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating room temperature, and pa- tient age as predictors of inadvertent hypothermia. Anesthesiology. 1992;77:252-257.
61. Wagner JA, Robinson S, Marino RP. Age and temperature regulation of humans in neutral and cold environments. J Appl Physiol. 1974;37:562-565.
62. Ozaki M Sessler DI, Matsukawa T, et al. The threshold for thermoregulatory vasoconstriction during nitrous oxide/ sevo- flurane anesthesia is reduced in elderly patients. AnesthAnalg. 1997;84: 1029-1033.
63. Cook DJ. Changing temperature management for cardiopulmonary bypass. Anesth Analg, 1999, 88(6):1254-1271.
64. Kasai T, Hirose M, Matsukawa T, et al. Preoperative blood pressure and intraoperative hypothermia during lower abdominal surgery. Acta Anaesthesiol Scand, 2001,45(8):1028-1031.
65. Frank SM, Fleisher LA, Beattie C, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA. 1997;277:1127-1134.
66. Stephen J, Thomas MD, eds. Manual of cardiac anesthesia. New York: Churchill Livingstone. 1993:355.
67. Kurz A, Seeler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995;7:359-366.
68. Cattaneo CG, Frank SM, Hesel TW, et al. The accuracy and precision of body temperature monitoring methods during regional and general anesthesia. Anesth Analg, 2000, 90(4):938-945.
69. Cork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. Anesth Analg. 1983.62: 211-4.
70. Holdcroft A, Hall GM, Cooper GM. Redistribution of body heat during anaesthesia. A comparison of halothane, fentanyl and epidural anaesthesia. Anaesthesia. 1979. 34:758-64.
71. Ramanathan NL. Anew weighting system for mean surface temperature of the human body. J Appl Physiol. 1964. 19:531-3.
72. Colin J, Timbal J, Houdas Y, Boutelier C, Guieu JD. Computation of mean body temperature from rectal and skin temperature. J Appl Physiol. 1971. 31:484-9.
73. El-Gamal N, EI-Kassabany N, Frank S, et al. Age-related thermo- regulatory differences in a warm operating room environment (approximately 26℃). Anesth Analg. 2000;90:694-698.
74. Corcoran, Tomas M.B, Cunningham, et al. Complications and treatment of mild hypothermia. Survey of Anesthesiology, 2002,46(3): 163-164.
75. Anttonen H, Puhakka K, Niskanen J, et al. Cutaneous heat loss in children during anesthesia. Br J Anaesth. 1995;74:306-310.
76. Bissonnette B, Sessler DI. Thermoregulatory thresholds for vasoconstriction in pediatric patients anesthetized with halothane or halothane and caudal bupivacaine. Anesthesiology. 1992;76: 387-392.
77. Seeler DI, McGuire J, Seeler AM. Perioperative thermal insulation. Anesthesiology. 1991;74:875-879.
78. Seeler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg. 1993;77:73-77.
79. Camus Y, Delva E Just B, Liengart A. Leg warming minimizes core hypothermia during abdominal surgery. Anesth Analg. 1993; 77:995-999.
80. Greif R, Rajek A, Laciny S, Bastanmehr H, Seeler D. Resistive heating is a more effective treatment for accidental hypothermia than metallic-foil insulation. Ann Emerg Med. 2000;35:337-345.
81. Kurz A, Kurz M, Poeschl G, Redl G, Hackl W. Forced-air warming maintains intraoperative normothermia better than circulating- water mattresses. Anesth Analg. 1993;77:89-95.
82. Krenzischek DA, Frank SM, Kelly S. Forced-air warming versus routine thermal care and core temperature measurement sites. J Post Anesth Nurs. 1995;10:69-78.
83. Steele M, Nelson MJ, Robinson WA et al. Forced-air speeds rewarming in victims of accidental hypothermia. Ann Emerg Med. 1996; 27: 479-484.
84. Camus Y, Delva E, Sessler DI, et al. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J ClinAnesth, 1995, 7(5):384-388.
85. Glosten B, Hynson J, Sessler DI, et al. Preanesthetic skin- surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg, 1993, 77(3):488-493.
86. Piotr K, Janicki, Michael S, Jill Janssen, Raymond F, Charles B. Comparison of two different temperature maintenance strategies during open abdominal surgery: Upper body forced-air warming versus whole body water garment. Anesthesiology, 2001,95:868-874.
87. Cabell LW, Perkowski SZ, Gregor T, et al. The effects of active peripheral skin warming on perioperative hypothermia in dogs. Vet Surg, 1997,26:79-85.
88. Hynson J, Sessler DI. Intraoperative warming therapies:A comparison of three devices. J Clin Anesth. 1992;4:194-199.
89. Bickler P, Sessler DI. Efficiency of airway heat and moisture exchangers in anesthetized humans. Anesth Analg. 1990; 71:415-418.
90. Stone DR, Downs JB, Paul WL, Perkins HM. Adult body tempe- rature and heated humidification of anesthetic gases during general anesthesia. Anesth Analg. 1981;60:736-741.
91．刘庆兰，宋红．手术中低体温对病人的影响及其护理措施．中华临床医药，2003，4(1)：92．
92．Burns SM，et al．保持手术病人正常体温的重要性及护理措施．国外医学护理学分册，2001，20(10)：473-474．
93. Smith CE, Gerdes E, Sweda S, et al. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. Anesth Analg, 1998, 87:37-41.
94. Seeler DI, Moayeri A. Skin-surface warming: Heat flux and central temperature. Anesthesiology. 1990;73:218-224.
95. Ikeda T, Sessler DI, Kikura M, et al. Less core hypothermia when anesthesia is induced with inhaled sevoflurane than with intravenous propofol. Anesth Analg, 1999, 88(4):921-924.
96. Noguchi Ⅰ, Matsukawa T, Ozaki M, et al. Propofol in low doses causes redistribution of body heat in male volunteers. Eur J Anaesthesiol, 2002, 19(9):677-681.
97．许钟麟，主编．洁净手术部建设实施指南．北京：科学出版社，2004．
98．魏革，刘苏君，主编．手术室护理学．北京：人民军医出版社，2002．
99．杨华明，易滨，主编．现代医院消毒学．北京：人民军医出版社．2002．
100．钟秀玲，程棣妍，主编．现代医院感染护理学．北京人军医出版社．1995．
2. Hervey GR. Thermoregulation. In: Emslie-Smith D, Paterson C, Scratcherd T, Read N, eds. Textbook of physiology, 11th edition. Edinburgh: Churchill-Livingstone. 1988: 510-33.
3. Sessler DI. Temperature monitoring. In: Millar RD, ed. Anesthesia. New York: Churchill Livingstone. 1994:1363-82.
4．张镜如，主编．生理学．第4版．北京：人民卫生出版社．1995．
5. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997.336: 1730-1737.
6. Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology, 1993, 78: 468-75.
7．刘小颖，吴新民．围术期低体温．中华麻醉学杂志．2003．23(9)：712-4．
8. Larry M, Gentilello MD, Vicente CMD, et al. Continuous arterivenous re-warming: Experimental results and thermodynamic model simulation of treatment for hypothermia. Trauma. 1990, 1436-48.
9．刘俊杰，赵俊，主编．现代麻醉学．第2版．北京：人民卫生出版社，1996
10. Hanagata K,Matsukawa T, Sessler DI, et al. Isoflurane and sevoflurane produce a dose-dependent reduction in the shivering threshold in rabbits. Anesth Analg, 1995, 81(3):581-584.
11. Kurz A, Seeler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypother- mia. J Clin Anesth. 1995;7:359-366.
12．张淑月，朱君宇，彭延增，等．术中低体温对患者麻醉恢复期的影响及护理干预．中华护理杂志，2003，38(3)：176-8．
13. Beilin B, Shavit Y, Jacob R, et al. Effect of mild perioperative hypothermia on cellular immune responses. Anesthesiology, 1998, 89:1133.
14. Daniel I, Sessler. Complications and treatment of mild hypothermia. Anesthesiology, 2001, 95:531-543.
15．盛卓人，主编．实用临床麻醉学．第3版．沈阳：辽宁科学技术出版社，1996．
16. Valeri CR, Khabbaz K, Khuri SF, Marquardt C, Ragno G; Feinhold H, et al. Effect of skin temperature on platelet function in patients undergoing extracorporeal bypass. J Thorac Cardiovasc Surg, 1992, 104:108-116.
17. Kurz A, Sessler DI, Lenhardt RA. Study of wound infections and temperature group: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996;334:1209-1215.
18. Sessler DI. Perioperative thermoregulation and Heat balance. Ann N Y Acad Sci, 1997, 15: 813757-813777.
19. Kurz A. Intraoperative hypothermia: pathophysiology and clinical sequelae. Wien Klin Wochenschr, 1997, 109:261-269.
20. Heier T, Caldwell JE, Seeler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthsiology, 1991, 74:815-819.
21. Seeler DI, Seeler AM. Experimental determination of heat flow parameters during induction of anesthesia. Anesthesiology, 1998, 89:657-665.
22. Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Seeler DIet al. Mild intraoperative hypothermia prolongs postoperative recovery. Anesthesiology. 1997, 87: 1318-1323.
23. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001; 95(2):531-543.
24. Negishi C, Hasegawa K, Mukai S, et al. Resistive-heating and forced-air warming are comparably effective. Anesth Analg, 2003, 96(6): 1683-1687.
25．吴阶平，裘法祖，主编．黄家驷外科学(上、中、下)．第6版．北京：人民卫生出版社，2000．
26. D.J. Buggy, A.W.A. Crossley. Thermoregulation, mild peri- operative hypothermia and post-anaesthetic shivering. British Journal of Anaesthesia. 2000.84: 615-28.
27. Sessler DI. Perioperative heat balance. Anesthesiology, 2000, 92(2):578-596.
28．赵俊，主编．新编麻醉学．北京：人民军医出版社，2002．
29. Sellden E, Branstrom R, Brundin T. Preoperative infusion of amino acids prevents postoperative hypothermia. British Journal of Anaesthesia. 1996.76: 227-34.
30. Sellden E, Brundin T, Wahren J. Augmented thermic effect of amino acids under general anaesthesia: a mechanism for prevention of anaesthesia-induced hypothermia. 1994.8:611-8.
31. Sellden E, Branstrom R, Brundin T. Augmented thermic effect of amino acids under general anaesthesia occurs predominantly in extra- splanchnic tissues. 1996.91: 431-9.
32. Lindahl SG. Sensing cold and producing heat. Anesthesiology. 1997. 86: 758-9.
33. Davis, Annette J.M, Bissonnette, et al. Thermal regulation and mild intraoperative hypothermia. Current Opinion in Anaesthesiology, 1999,12(3):303-309.
34．妇科：陈淑坚,主编．妇产科护理学．第1版．北京：人民卫生出版社,1991．
35. Kim JS, Ikeda T, Sessler DI. Turakhia M, Jeffrey R. Epidural anesthesia reduces the gain and maximum intensity of shivering. Anesthesiology. 1998. 88: 851-7.
36. Kurz A, Plattner O, Sessler DI, Huemer G, Redl G, Lackner F. The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients. Anesthesiology. 1993. 79:465-9.
37. Kura A, Xiong J, Sessler DI, Dechert M, Noyes K, Belani K. Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstricition in humans. Anesthesiology. 1995. 83:1212-9.
38. Ozaki M, kurz A, Sessler DI, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology. 1994. 81:282-8.
39. Scherer R. Intraoperative heat conservation. A lot of hot air? Anaesthesist, 1997, 46:81-90.
40. Sessler DI. Olofsson CI, Rubinstein EH. The thermoregulatory threshold in humans during nitrous oxide-fentanyl anesthesia. Anesthesiology, 1988, 69:357-364.
41. Sessler DI, Olofsson CI, Rubinstein EH, Beebe JJ. The thermoregulatory threshold in humans during halothane anesthesia. Anesthesiology, 1988, 68:836-842.
42. Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng C. Propofol linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology, 1995, 82:1169-1180.
43. Xiong J, Kurz A, Sessler DI, Plattner O, Christensen R, Dechert M, Ikceda T. Isoflurane produces marked and non-linear decreases in the vasoconstriction and shivering thresholds. Anesthesiology, 1996, 85:240-245.
44. Annadata RS, Sessler DI, Tayefeh F, Kurz A, Dechert M. Desflurane slightly increases the sweating threshold, but produces marked, non-linear decreases in the vasoconstriction and shivering thresholds. Anesthesiology, 1995, 83:1205-1211.
45. Kurz A, Go JC, Sessler DI, Kaer K, Larson M, Bjorksten AR. Alfentanil slightly increases the swrating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology, 1995,83: 293-299.
46. Kurz A, Ikeda T, Sessler DI, Larson M, Bjorksten AR, Dechert M, Christensen R. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology, 1997, 86:1046-1054.
47. Toyota K, Sakura S, Saito Y, et al. The effect of pre-operative administration of midazolam on the development of intraoperative hypothermia. Anaesthesia, 2004, 59(2):116-121.
48. Young DM. Risk factors for hypothermia in psychiatric patients. Ann Clin Psychiatry, 1996, 8(2):93-97.
49. Kudoh A, Takase H, Takazawa T. Chronic treatment with antipsychotics enhances intraoperative core hypothermia. Anesth Analg, 2004, 98(1):111-115.
50. Kudoh A, Takase H, Takazawa T. Chronic treatment with antidepressants decreases intraoperative core hypothermia. Anesth Analg, 2003, 97(1):275-279.
51. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology, 2002, 96(2):467-484.
52. Morris RH, Wilkey BY. The effects of ambient temperature on patient temperature during surgery not involving body cavities. Anesthesiology. 1970;32:102-107.
53. Morris RH. Operating room temperature and the anesthetized paralyzed patient. Arch Surg. 1971;103:95-97.
54. Sahin A, Aypar U. Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering: Comparison of two anesthetic regimens. Acta Anaesthesiology Scand, 2002,46(1):64-67.
55. Reo CR Effect of bowel exposure on body temperature during surgical operations. AM J Surg, 1971,122:13-15.
56. Just B, Trevien V, Delva E, Lienhart A. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology. 1993;79:214-218.
57. Hynson Jm, Sessler DI, Moayeri A, et al. The effects of pre-induc- tion warming on temperature and blood pressure during propofol/ nitrous oxide anesthesia. Anesthesiology. 1993 ;79:219-228.
58. Nguyen NT, Fleming NW, Singh A, et al. Evaluation of core temperature during laparoscopic and open gastric bypass. Obes Surg, 2001, 11(5):570-575.
59. Kurz A, Sessler DI, Narzt E, Lenhart R. Morphometric influences on intraoperative core temperature changes. Anesth Analg. 1995; 80:562-567.
60. Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating room temperature, and pa- tient age as predictors of inadvertent hypothermia. Anesthesiology. 1992;77:252-257.
61. Wagner JA, Robinson S, Marino RP. Age and temperature regulation of humans in neutral and cold environments. J Appl Physiol. 1974;37:562-565.
62. Ozaki M Sessler DI, Matsukawa T, et al. The threshold for thermoregulatory vasoconstriction during nitrous oxide/ sevo- flurane anesthesia is reduced in elderly patients. AnesthAnalg. 1997;84: 1029-1033.
63. Cook DJ. Changing temperature management for cardiopulmonary bypass. Anesth Analg, 1999, 88(6):1254-1271.
64. Kasai T, Hirose M, Matsukawa T, et al. Preoperative blood pressure and intraoperative hypothermia during lower abdominal surgery. Acta Anaesthesiol Scand, 2001,45(8):1028-1031.
65. Frank SM, Fleisher LA, Beattie C, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA. 1997;277:1127-1134.
66. Stephen J, Thomas MD, eds. Manual of cardiac anesthesia. New York: Churchill Livingstone. 1993:355.
67. Kurz A, Seeler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995;7:359-366.
68. Cattaneo CG, Frank SM, Hesel TW, et al. The accuracy and precision of body temperature monitoring methods during regional and general anesthesia. Anesth Analg, 2000, 90(4):938-945.
69. Cork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. Anesth Analg. 1983.62: 211-4.
70. Holdcroft A, Hall GM, Cooper GM. Redistribution of body heat during anaesthesia. A comparison of halothane, fentanyl and epidural anaesthesia. Anaesthesia. 1979. 34:758-64.
71. Ramanathan NL. Anew weighting system for mean surface temperature of the human body. J Appl Physiol. 1964. 19:531-3.
72. Colin J, Timbal J, Houdas Y, Boutelier C, Guieu JD. Computation of mean body temperature from rectal and skin temperature. J Appl Physiol. 1971. 31:484-9.
73. El-Gamal N, EI-Kassabany N, Frank S, et al. Age-related thermo- regulatory differences in a warm operating room environment (approximately 26℃). Anesth Analg. 2000;90:694-698.
74. Corcoran, Tomas M.B, Cunningham, et al. Complications and treatment of mild hypothermia. Survey of Anesthesiology, 2002,46(3): 163-164.
75. Anttonen H, Puhakka K, Niskanen J, et al. Cutaneous heat loss in children during anesthesia. Br J Anaesth. 1995;74:306-310.
76. Bissonnette B, Sessler DI. Thermoregulatory thresholds for vasoconstriction in pediatric patients anesthetized with halothane or halothane and caudal bupivacaine. Anesthesiology. 1992;76: 387-392.
77. Seeler DI, McGuire J, Seeler AM. Perioperative thermal insulation. Anesthesiology. 1991;74:875-879.
78. Seeler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg. 1993;77:73-77.
79. Camus Y, Delva E Just B, Liengart A. Leg warming minimizes core hypothermia during abdominal surgery. Anesth Analg. 1993; 77:995-999.
80. Greif R, Rajek A, Laciny S, Bastanmehr H, Seeler D. Resistive heating is a more effective treatment for accidental hypothermia than metallic-foil insulation. Ann Emerg Med. 2000;35:337-345.
81. Kurz A, Kurz M, Poeschl G, Redl G, Hackl W. Forced-air warming maintains intraoperative normothermia better than circulating- water mattresses. Anesth Analg. 1993;77:89-95.
82. Krenzischek DA, Frank SM, Kelly S. Forced-air warming versus routine thermal care and core temperature measurement sites. J Post Anesth Nurs. 1995;10:69-78.
83. Steele M, Nelson MJ, Robinson WA et al. Forced-air speeds rewarming in victims of accidental hypothermia. Ann Emerg Med. 1996; 27: 479-484.
84. Camus Y, Delva E, Sessler DI, et al. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J ClinAnesth, 1995, 7(5):384-388.
85. Glosten B, Hynson J, Sessler DI, et al. Preanesthetic skin- surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg, 1993, 77(3):488-493.
86. Piotr K, Janicki, Michael S, Jill Janssen, Raymond F, Charles B. Comparison of two different temperature maintenance strategies during open abdominal surgery: Upper body forced-air warming versus whole body water garment. Anesthesiology, 2001,95:868-874.
87. Cabell LW, Perkowski SZ, Gregor T, et al. The effects of active peripheral skin warming on perioperative hypothermia in dogs. Vet Surg, 1997,26:79-85.
88. Hynson J, Sessler DI. Intraoperative warming therapies:A comparison of three devices. J Clin Anesth. 1992;4:194-199.
89. Bickler P, Sessler DI. Efficiency of airway heat and moisture exchangers in anesthetized humans. Anesth Analg. 1990; 71:415-418.
90. Stone DR, Downs JB, Paul WL, Perkins HM. Adult body tempe- rature and heated humidification of anesthetic gases during general anesthesia. Anesth Analg. 1981;60:736-741.
91．刘庆兰，宋红．手术中低体温对病人的影响及其护理措施．中华临床医药，2003，4(1)：92．
92．Burns SM，et al．保持手术病人正常体温的重要性及护理措施．国外医学护理学分册，2001，20(10)：473-474．
93. Smith CE, Gerdes E, Sweda S, et al. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. Anesth Analg, 1998, 87:37-41.
94. Seeler DI, Moayeri A. Skin-surface warming: Heat flux and central temperature. Anesthesiology. 1990;73:218-224.
95. Ikeda T, Sessler DI, Kikura M, et al. Less core hypothermia when anesthesia is induced with inhaled sevoflurane than with intravenous propofol. Anesth Analg, 1999, 88(4):921-924.
96. Noguchi Ⅰ, Matsukawa T, Ozaki M, et al. Propofol in low doses causes redistribution of body heat in male volunteers. Eur J Anaesthesiol, 2002, 19(9):677-681.
97．许钟麟，主编．洁净手术部建设实施指南．北京：科学出版社，2004．
98．魏革，刘苏君，主编．手术室护理学．北京：人民军医出版社，2002．
99．杨华明，易滨，主编．现代医院消毒学．北京：人民军医出版社．2002．
100．钟秀玲，程棣妍，主编．现代医院感染护理学．北京人军医出版社．1995．