VI. Effects of intraoperative body temperature reduction
（I）Effects on the cardiovascular system
(II)Effects on coagulation
Weakened platelet function reduces clotting factor activity, leading to prolonged bleeding time and increasing the amount of bleeding. Low temperature also leads to stagnation of blood in the stagnation of blood in the veins, which can easily cause deep vein thrombosis.
Body temperature is below 35°C, the following indicators are significantly prolonged with temperature The following indicators are significantly prolonged with decreasing temperature:
Partially activated prothrombin time (APTT)
Prothrombin time (PT)
Prothrombin time (TT)
(III) Increased incision infections
Lower body temperature can directly impair the immune function, reduce the supply of blood oxygen to the skin, and protein and glial synthesis; at the same time, poor perfusion of peri-incisional tissues and delayed incision healing lead to an increased rate of The rate of wound infection increases.
Intraoperative temperatures below 35°C were associated with a threefold increase in wound infection and a 20% longer hospital stay.
Abstracted from:Zhang Y. Care of perioperative hypothermia[J]. Xinjiang Chinese medicine,2011.29(04).92-94.Operating room nursing 512
(IV)Delayed awakening
-Decreased visceral blood flow in hypothermia
-Decreased liver function
-Reduced renal blood flow and glomerular filtration rate
-Slower drug metabolism
Hypothermia inhibits sympathetic nerve activity and reduces catecholamine production, which weakens the body's response to external stimuli, while anesthetics are metabolized in the body at a slower rate, resulting in a relatively longer time to wakefulness and extubation.
(V)Metabolic disorder
Affects the body's metabolism
-Slowed nerve conduction
-Acidosis, electrolyte imbalance
-Immune dysfunction
-Increased body oxygen consumption
-Changes in the internal environment
Hypothermia reduces the body's metabolic rate, and for every 1C lower body temperature, the metabolic rate is reduced by 6%. At a body temperature of 28C, metabolic rate is 50% of normal.
Abstracted from:Yu Dingning,Li Duo,The danger of hypothermia and its treatment[J]. Overseas Medicine: Surgery Foreign Medicine:Surgery,2004,31(5):258-261.
VII.Methods of detecting body temperature during surgery
In fact, the difference between core and body surface temperatures is difficult to estimate without a linear relationship, so it is recommended to use a monitor body cavity probe to accurately detect core body temperature when conditions permit
VIII.Prevention of perioperative hypothermia and care
(I)Psychological care interventions
Pre-operative visit (assessment):
Through the preoperative visit, the patient's condition is adequately assessment, make a nursing diagnosis, propose a nursing plan, make an to adequate preparation, and implement warming measures on the day of surgery to
prevent hypothermia.
At the same time, through the preoperative visit, increase the nurse-patient familiarity, which is conducive to better communication between nurses and patients. recognition, which is conducive to better communication between patients and nurses and reduces patients' nervousness. patients' nervousness and lowering their threshold for cold stimuli. The patient's threshold for cold stimulation will be lowered.
(II)Environmental temperature
Dynamically regulated room temperature 21-25°C. Maintaining humidity at 30-60%
Maintaining proper temperature and humidity can reduce heat loss from the skin and is an effective way to prevent hypothermia.
The temperature and humidity of the operating room is controlled by the central air conditioner, the temperature of the room will be adjusted to 25°C before the start of the patient's operation, and only after the start of the operation will it be adjusted to 21-23°C. It is guaranteed that the patient will not be affected by the environment that affects the change of body temperature.
(III) Liquid warming
A. Infusion fluids warmed to 37°C:
Physiological saline or water for injection used to disinfect skin and rinse is placed in a thermostat and adjusted to 37°C. Take it out of the thermostat before use to reduce body heat loss.
B. Use of infusion warmer during blood transfusion:
When performing a large amount of blood transfusion, a blood transfusion warming device will be used to ensure that the fluid injected into the patient's body is close to the patient's body temperature.
(IV) Use insulation equipment
A gentle inflatable blanket is used to cover the non surgical area, applying a certain temperature to the body surface temperature of high convection gas is applied to the body surface to increase the patient's body surface temperature, reducing the internal heat to the lower temperature environment, and play the role of isolate the body and the surrounding cold environment, transdermal skin active heating.
(V)Reduced exposure time for position change placement
A.Develop a standardized position placement process to reduce exposure time for position changes
B.Positioning for Specialized Surgical Positions
Orthopedics: prone position
Thoracic: side-lying position
Urology: Side-lying position
Lithotomy → prone position: percutaneous nephrolithotomy (PCNL), etc.
(VI)Waterproofing
Avoid or minimize soaking of sheets.
Cover the sterile sheet with a layer of plastic bag (provided that it does not contaminate and affect the surgical field).
Prevent soaking of the patient and bed linen with large amounts of rinses during surgery.
For surgeries that require large amounts of perfused water, such as urological surgeries (prostate electrocision, percutaneous nephrolithotomy, etc.), Open surgery (open radical treatment of intestinal cancer, liver resection, etc.), gynecological cancer surgery, etc.
Summary:
The phenomenon of intraoperative hypothermia has gradually attracted the attention of clinical staff through the controlling body surface and body cavity heat dissipation before and during surgery, and adopting a variety of nursing measures to create a comfortable internal and external body environment can effectively prevent intraoperative hypothermia in patients. Reduced It can reduce many complications caused by hypothermia, alleviate the pain of patients, shorten the hospitalization date of hospitalization, and reduce the medical cost of patients, which is conducive to early recovery.
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