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2016, vol. 73, br. 6, str. 566-571
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Efikasnost spoljašnjeg zagrevanja u ublažavanju hipotermije kod hirurških bolesnika
Efficacy of external warming in attenuation of hypothermia in surgical patients
aUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd bGalenika, Belgrade cUniverzitet u Kragujevcu, Medicinski fakultet dUniverzitet odbrane, Vojna akademija, Beograd eTechnical Testing Centre, Belgrade
e-adresa: sonja.radakovic@vma.mod.gov.rs
Sažetak
Uvod/Cilj. Hipotermija kod hirurških bolesnika može biti posledica dugotrajne hirurške intervencije, opšte anestezije i niske temperature vazduha u operacionoj sali. Postoperativna hipotermija može dovesti do brojnih postoperativnih komplikacija kao što su aritmija, ishemija miokarda, hipertenzija, krvarenje, infekcija rane, koagulopatija i produženo dejstvo mišićnih relaksanata. Za prevenciju ovog stanja koristi se spoljašnje zagrevanje. Cilj ove studije bio je procena efikasnosti sistema za spoljašnje zagrevanje radi ublažavanja hipotermije kod bolesnika podvrgnutih dugotrajnim hirurškim procedurama. Metode. Ovo istraživanje sprovedeno je u Vojnomedicinskoj akademiji u Beogradu na 30 bolesnika oba pola koji su nasumice bili podeljeni u dve jednake grupe: u jednoj je primenjeno spoljašnje zagrevanje madracem sa toplim vazduhom, dok je druga bila bez dodatnog zagrevanja (kontrolna grupa). U toku hirurške intervencije, kao i tokom postoperativnog perioda buđenja, promene unutrašnje temperature praćene su preko ezofagusne sonde (Te), a promene temperature kože intraoperativno preko kontrolnih tačaka na desnoj šaci (Th) i desnom stopalu (Tf). Srčana frekvencija i vrednosti krvnog pritiska praćeni su kontinuirano tokom hirurške intervencije, kao i u toku perioda buđenja. Rezultati. U zagrevanoj grupi, prosečne vednosti Te, Tf i Th nisu se značajno menjale tokom intraoperativnog i postoperativnog perioda. U kontrolnoj grupi, prosečna vrednost Te značajno se smanjila tokom intraoperativnog perioda (sa 35,61 ± 0,35°C u nultom minutu na 33,86 ± 0,51°C u 120. minutu). U odnosu na zagrevanu grupu, Te je u kontrolnoj grupi bila značajno niža u svim posmatranim periodima. Prosečne vrednosti Tf i Th značajno su se smanjile u kontrolnoj grupi (sa 30,83 ± 1,85 u 20. minutu na 29,0 ± 1,39°C u 120. minutu, odnosno sa 32,75 ± 0,96 na 31,05 ± 1,09°C). Zaključak. Rezultati ove studije podvrđuju da spoljašnje zagrevanje madracem s toplim vazduhom može da ublaži hipotermiju, odnosno da spreči značajno sniženje unutrašnje temperature do kojeg dolazi tokom izlaganja stresu usled hladnoće tokom hirurške intervencije.
Abstract
Background/Aim. Hypothermia in surgical patients can be the consequence of long duration of surgical intervention, general anaesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, and prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition. The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures. Methods. The study was conducted in the Military Medical Academy in Belgrade. A total of 30 patients of both genders underwent abdominal surgical procedures, randomly divided into two equal groups: the one was externally warmed using warm air mattress (W), while in the control group (C) surgical procedure was performed in regular conditions, without additional warming. Oesophageal temperature (Te) was used as indicator of changes in core temperature, during surgery and awakening postoperative period, and temperature of control sites on the right hand (Th) and the right foot (Tf) reflected the changes in skin temperatures during surgery. Te and skin temperatures were monitored during the intraoperative period, with continuous measurement of Te during the following 90 minutes of the postoperative period. Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period. Results. In the W group, the average Te, Tf and Th did not change significantly during the intraoperative as well as the postoperative period. In the controls, the average Te significantly decreased during the intraoperative period (from 35.61 ± 0.35°C at 0 minute to 33.86 ± 0.51°C at 120th minute). Compared to the W group, Te in the C group was significantly lower in all the observed periods. Average values of Tf and Th significantly decreased in the C group (from 30.83 ± 1.85 at 20th minute to 29.0 ± 1.39°C at 120th minute, and from 32.75 ± 0.96 to 31.05 ± 1.09°C, respectively). Conclusion. The obtained results confirm that the external warming using warm air mattress was able to attenuate hypothermia, i.e. substantial decrease in core temperature, compared with the similar exposure to cold stress in the control group.
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