低溫-在麻醉中的應(yīng)用-昆明醫(yī)學(xué)院-臨床麻醉學(xué)課課件

Chapter12

Bodytemperaturemanagementduringanesthesia

Temperaturedropduringoperation一、Reasons：<36℃1.Age：（1）older-thermoregulationfunctionislower（2）premature、neonatus、infant-thermoregulatorycenterisimperfect

2.Influenceofoperativeprocedure：（1）colddisinfectantsolutionandrinsesolutionTemperaturedropduringoperation（2）largedoseofcoldbloodtransfusionandinfusingfluid3.roomtemperature：4.anestheticaction：（1）fieldblockanaesthesia（2）generalanaesthesia5.insufficientheatproduction：Temperaturedropduringoperation二、Heatpreservation：1.EvaluationofPreoperativeandPreheating2.Bodysurfaceheating3.WarmingtheinfusedfluidPerioperativeFervescence

一、Reasons：1.Patient′sstate2.Temperatureandhumidityofoperatingroomishigh3.Influenceofanesthesia4.Surgeryfactors5.MalignanthyperthermiaPerioperativeFervescence

二、PreventionandCure：1.Continuousmonitoringofbodytemperature2.Correctlyselectanticholinergicagent3.SuitabletemperatureandhumidityofoperatingroomPerioperativeFervescence

4.Avoidhypoxiaandcarbondioxideaccumulation5.Avoidiatrogenicfervescence6.ReducethetemperaturebyphysicalmethodRelationbetweenbodytemperatureandmetabolicratebodytemperature（℃）metabolicrate（%）36.810031.875~8030.060~7026.85020.02516.82015.0156.86ArtificialhypothermiaArtificialhypothermia

一、Indications：1.Operationonvesselsofheart：（1）Cardiosurgery（2）Operationonmajorvessels（3）SafetimelimitArtificialhypothermiaSafetimelimitofdifferentbodytemperature

bodytemperaturecirculationblockingtime（℃）（min）32~30℃8~930~28℃10~1528~18℃15~45<18℃45~60Artificialhypothermia2.Neurosurgery：3.Others：（1）Operationonliverandkidney（2）Largewoundandoperationwhichisbleedingalot（3）Controlthehyperpyrexia（4）CerebralresuscitationArtificialhypothermiaTimelimitofcirculationblockingofmajororganatdifferenttemperature（min）

37℃28~32℃25℃Brain3814~15Spinalcord30~45Kidney30~4060Liver2060Artificialhypothermia

二、Cooling、Rewarming、MonitoringandAnnouncements：

（一）AnestheticManagement1.Threemainpoints：（1）Avoidcolddegensereflex；（2）Ccompletelymusclerelaxation；（3）VasodilatationofperipheralvesseliswellArtificialhypothermia

2.AnestheticManagement：（1）preanestheticmedication（2）induction（3）maintenance（4）lowdoseofchlorpromazinebeforecooling：0.25~0.5mg/kg→preventshiverandvasospasmArtificialhypothermia

（二）Methodofreducethetemperature1.Surfacecooling：（1）icewaterbathoricecrumbs（2）icebag、ice-cap（3）ectothermicblanketArtificialhypothermia

2.Bodycavitycooling3.Bloodcoolingusingextracorporealcirculation4.Extracorporealcirculation+Surfacecooling5.Infusingcoldfluidintravenously（4~6℃）Artificialhypothermia

（三）Rewarming1.Surfacerewarming：hotwaterbottle、electricblanket、ectothermicblanket2.Bodycavityrewarming：3.HematogenousrewarmingusingextracorporealcirculationArtificialhypothermia

（四）Monitoring：1.Bodytemperature：（1）nasopharyngealtemperature（2）esophagealtemperature（3）rectaltemperature（4）bloodtemperature2.Circulatorymonitoring：ECG、BP、CVP3.Others：urinevolume、electrolyte、bloodgas、haemorheologyArtificialhypothermia

三、Announcements1.Avoidcolddegensereflex2.Avoidfrostbite3.Whensurfacerewarming：（1）Avoidburn（2）Preventhypotensionandarhythmia（3）Preventresponsivehyperpyrexia4.Preventhypoxiaandmetabolicacidosis5.PreventventricularfibrillationandbraindamageArtificialhypothermia

四、Complications1.Colddegensereflex2.Arhythmia：ventricularfibrillation（1）Criticaltemperature：26~28℃（2）Evokedreasons：

①unbalancebetweensympatheticnerveandpneumogastricnerve②acid-baseimbalance③electro