體溫管理
預保溫:預防低體溫的關鍵
僅僅幾度的溫差,就能對維持正常體溫產生關鍵影響。接受全身或區域性麻醉的病患,由於體溫調節機制受影響,容易在手術過程中發生低體溫。在麻醉誘導前進行短時間的預保溫可以幫助減少手術中的熱量損失。
麻醉對患者核心體溫的影響
研究顯示,在麻醉誘導後的一小時內,如果手術病人未進行主動式保溫,核心體溫可能會下降多達 1.6°C。這是因為麻醉引起血管擴張,導致體內較溫暖的血液從核心區域流向較冷的周邊組織。
在正常情況下,人體會在非常狹窄的範圍內調節體溫,核心體溫比周邊高出約 2 到 4°C。 這種核心與周邊之間的溫度差異是由體溫調節機制中的血管收縮所引起的。
麻醉會引起血管擴張,導致較熱的核心血液流向較冷的周邊區域,並與周邊血液混合。隨著血液循環,這些血液逐漸降溫,回流至心臟時,核心體溫會因此下降。這個過程稱為「再分佈體溫降低」(Redistribution Temperature Decrease,RTD)。
使用熱空氣式保溫毯可以提高周邊組織的溫度,限制核心部位通過再分佈體溫降低(RTD)散失的熱量。 溫暖的周邊組織可以限制血液冷卻的速度,並讓血液以更高的溫度回流到核心體溫。
維持正常體溫可以幫助降低風險
維持正常的核心體溫是病人安全的重要組成部分。核心體溫偏離正常範圍可能對所有接受手術的病人構成風險,並與增加手術併發症的風險有關,包括:
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