Kāohi a mālama ʻana i ka Hypothermia Intraoperative - Māhele 1
I. ʻO ka manaʻo o ka hypothermia:
ʻO ka mahana wela ma lalo o 36 ℃ he hypothermia
ʻO ka wela kumu ka wela i loko o ke aʻa pulmonary o ke kino, tympanic membrane, esophagus, nasopharynx, rectum and bladder, etc.
ʻO ka maʻi maʻi maʻi maʻi maʻi maʻi (Indvertentperioperative hypothermia, IPH), hiki ke loaʻa ka hypothermia haʻahaʻa ma 50% -70% o nā maʻi anesthesiology a me nā maʻi ʻokiʻoki.
II. Ka helu ʻana i ka Hypothermia:
ʻO ka maʻi maʻi, ʻo ka wela nui o 34 ℃-36 ℃ i kapa ʻia he hypothermia haʻahaʻa
34 ℃-30 ℃ e like me ka hypothermia pāpaʻu
ʻO 30 ℃-28 ℃ ka hypothermia haʻahaʻa
<20 ℃ no ka hypothermia hohonu
<15 ℃ ka hypothermia hohonu loa
III. Nā kumu o ka hypothermia intraoperative
(I) Hoʻokumu iā ia iho:
A. Makahiki:
ʻO nā poʻe ʻelemakule: ʻAʻohe hana thermoregulation maikaʻi ʻole (ka ʻiʻo ʻana o ka ʻiʻo, haʻahaʻa ke kani o ka ʻiʻo, ke koko ʻili, hoʻemi ʻia ka hiki ke hoʻopaʻa ʻia o ka paipu, haʻahaʻa ka hana mālama ʻana i ka cardiovascular).
ʻO ka momona he insulator wela ikaika, hiki iā ia ke pale i ka nalowale o ka wela o ke kino.
Hiki i nā mea momona a pau ke ʻike i ka mahana, a ua wela lākou ma ka hoʻokuʻu ʻana i ka ikehu. Ua ʻike ʻia ka haʻawina ʻo Harvard University e pili ana kēia kaʻina hoʻomehana i kahi protein i kapa ʻia ʻo coupling protein-1. Ke ʻike ʻia ke kino i ke anu, e pālua ka nui o ka hui pū ʻana i ka protein-1.
Ma lalo o nā kūlana maʻamau, pono ka poʻe maʻi e hoʻokē ʻai ma kahi o 12 mau hola ma mua o ka ʻoki ʻana. Inā maikaʻi ʻole ko lākou kino, e ʻoi aku ka maʻalahi o ka hoʻoulu ʻana i ke anuanu, a laila e hoʻonāwaliwali ke kūpaʻa. ʻO ka hoʻoulu anuanu i hana ʻia e ka ʻokiʻoki hiki ke hoʻohaʻahaʻa i ka wela o ke kino.
C. Kūlana o ka manaʻo
ʻO ka loli o ka manaʻo o ka mea maʻi e like me ka makaʻu, ka haʻalulu, a me ka hopohopo e hoʻohele hou ʻia ke koko, e pili ana i ka hoʻihoʻi ʻana o ke koko i ka puʻuwai a me ka microcirculation, a ua maʻalahi ke kumu o ka hypothermia i ka wā o ka hana.
D. Ma'i ko'iko'i
ʻO ka maʻi koʻikoʻi, nāwaliwali loa: hiki ke hana i ka wela haʻahaʻa.
Hoʻopilikia i ka pono o ka ʻili: ʻeha nui, ʻeha ʻeha, ʻeha nui.
(II)Kaiapuni
Hoʻomalu ʻia ka mahana o ka lumi hana ma 21-25 ° C. malalo o ka wela kino.
ʻO ka mahana maʻamau o ka lumi hana holo laminar a me ka convection wikiwiki o ka ea i loko e hoʻonui i ka hoʻoheheʻe wela o ke kino o ka mea maʻi, ʻoi aku ka nui o ka hāʻule ʻana o ke kino o ka mea maʻi.
(III) Hoʻopau wela o ke kino
A. Ka hoʻopau ʻana i ka ʻili:
He haʻahaʻa ka mahana o ka disinfectant, a hiki ke hoʻokō ʻia ke kumu o ka disinfection ma hope o ka maloʻo ʻana o ka disinfection. ʻO ka volatilization o ka disinfectant e lawe i ka wela a hoʻohaʻahaʻa i ka mahana o ke kino.
B. ʻO ke kahe nui ʻana:
ʻO ka holoi ʻana me ka nui o ka paʻakai maʻamau a i ʻole ka wai no ka hoʻoheheʻe ʻana i ka wā o ka hana e alakaʻi ai i ka nalowale o ka wela o ke kino, ʻo ia ke kumu e hāʻule ai ka wela o ke kino o ka mea maʻi.
C. He lōʻihi ka lōʻihi o ka ʻoki ʻana, a ʻoi aku ka lōʻihi o ka hōʻike ʻana o ka umauma a me ka ʻōpū
D. ʻAʻole ʻike nā limahana lapaʻau i ka mālama ʻana i ka wela
IV.Anesthesia
Hiki i nā lāʻau lapaʻau ke hoʻololi i ka helu i hoʻonohonoho ʻia o ke kikowaena thermoregulatory.
ʻO ka maʻi maʻi maʻamau - hiki i ka nui o nā anesthetics ke hoʻomāhuahua pololei i nā kīʻaha koko, a hiki i nā mea hoʻomaha hoʻomaha ke pale i ka pane ʻana i ka haʻalulu.
ʻĀpana ʻāpana ʻāpana - ua ālai ʻia nā afferent fiber o ke ʻano anuʻu peripheral, i manaʻo hewa ke kikowaena he mahana ka wahi i hoʻopaʻa ʻia.
V. Ka wai a me ke koko
ʻO ka hoʻokomo ʻana i ka nui o ka wai a me ke koko waiwai ma ka lumi like ʻole a i ʻole ka nui o ka wai hoʻoheheʻe ʻia i ka lumi wela i ka wā o ka hana e loaʻa ai ka hopena o ka 'dilution anu' a hoʻoulu i ka hypothermia.
Hiki ke hoʻemi ʻia ka wela o ke kino ma kahi o 0.25°C i loko o ka infusion intravenous o 1L wai ma ka lumi wela a i ʻole 1 ʻāpana o 4C koko i nā pākeke.
Wehe ʻia mai: Wu Zhimin. ʻO Yue Yuan. Ka noiʻi a me ka mālama ʻana i ka maʻi maʻi ma ka wā o ka hoʻololi ʻana i ke akepaʻa anesthesia hana]. Ka Nupepa Pākē no nā kahu hānai, 2005
