重度烧伤术后低体温患者复温方案的制订及实践

doi:10.3761/j.issn.0254-1769.2019.10.013

摘要/Abstract

摘要： 目的总结重度烧伤患者术后低体温的管理经验。方法组建多学科管理团队,基于循证医学制订重度烧伤患者术后低体温管理方案,包括建立复温单元、明确复温启动和终止标准、核心温度监测方法及监测频率、适合烧伤患者的复合复温措施、复温仪器的维护管理、护士复温技能的培训考核等。结果重度烧伤患者低体温持续时间由（274.38±149.43） min缩短至（107.89±65.39） min,复合复温方案执行率由21.88%提高至83.33%,核心体温监测正确率由18.75%提高至97.22%。结论重度烧伤术后低体温患者复温方案有利于提高护理质量。

关键词: 烧伤, 低温, 复温, 循证实践, 围手术期护理

Abstract: Objective This article summarized experiences of postoperative hypothermia management for severe burn patients. Methods We established multidisciplinary management team and formulated postoperative hypothermia rewarming program for severe burn patients based on evidence,including set-up of rewarming unit,clarification of starting and ending criteria of rewarming,the method and frequency of core temperature monitoring,complex rewarming interventions for burn patients,management of rewarming equipment,training and evaluation of nurses' rewarming skills. Results The continuation time of hypothermia was decreased from（274.38±149.43） min to（107.89±65.39） min. The compliance of complex rewarming interventions increased from 21.88% to 83.33%. The accuracy rate of core temperature monitoring was improved from 18.75% to 97.22%. Conclusion The postoperative hypothermia rewarming program of severe burn patients is beneficial to improve the quality of nursing care.

Key words: Burns, Hypothermia, Rewarming, Evidence-Based Practice, Perioperative Nursing

徐彩娟, 沈鸣雁, 卢福长, 陈华清, 傅亚红, 胡雁. 重度烧伤术后低体温患者复温方案的制订及实践[J]. 中华护理杂志, 2019, 54(10): 1509-1513.

XU Caijuan, SHEN Mingyan, LU Fuchang, CHEN Huaqing, FU Yahong, HU Yan. The establishment and practice of postoperative hypothermia rewarming program for severe burn patients[J]. Chinese Journal of Nursing, 2019, 54(10): 1509-1513.

图/表 3

参考文献 24

[1]	Sessler DI . Mild perioperative hypothermia[J]. N Engl J Med, 1997,336(24):1730-1737.
[2]	Yi J, Lei YJ, Xu SY , et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia:national study in China[J]. PLoS One, 2017,12(6):e0177221.
[3]	李乐之, 路潜 . 外科护理学[M]. 北京: 人民卫生出版社, 2012.
[4]	安虹, 李军, 米雪飞 , 等. 大面积烧伤患者切痂植皮术中体温变化特点分析[J]. 护理学报, 2014,21(1):61-62.
[5]	Yu R, Fan XM, Bannykh SI . Complete pituitary infarction associated with hypothermia and brain death[J]. Endocrinol Nutr, 2016,63(5):250-252.
[6]	李杨, 陈伟元, 张彩铃 , 等. 围手术期综合保温对大面积烧伤患者麻醉影响的临床研究[J]. 山西医药杂志, 2015,44(4):412-414.
[7]	Kruse CR, Nuutila K, Lee CC , et al. The external microenvironment of healing skin wounds[J]. Wound Repair Regen, 2015,23(4):456-464.
[8]	Bishop S, Maguire S . Anaesthesia and intensive care for major burns[J]. Continuing Educ Anaesth Crit Care Pain, 2012,12(3):118-122.
[9]	朱凌雅, 郭松雪, 吴攀 , 等. 创面温度与创面愈合的关系研究进展[J]. 中华烧伤杂志, 2018,34(11):829-832.
[10]	Laveena Sharma . Temperature management burns):operating room[J/OL]. JBI Evidence Summary. ( 2017- 07- 20)[2018-08-29]. http://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi&S=OJCDFPMOJCDDDGBPNCDKMFGCCJEAAA00&Complete+Reference=S.sh.17%7c1%7c1&Counter5=SS_view_found_complete%7cJBI13576%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI13576%7cjbi%7cjbidb%7cjbi .
[11]	Laveena Sharma . Temperature management(burns):emergency department[J/OL]. JBI. Evidence Summary. (2017- 07- 20)[2018-08-29]. http://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi&S=OJCDFPMOJCDDDGBPNCDKMFGCCJEAAA00&Complete+Reference=S. sh. 17%7c2%7c1&Counter5=SS_view_found_complete%7cJBI13577%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI13577%7cjbi%7cjbidb%7cjbi .
[12]	Laveena Sharma . Temperature management(burns):intensive care unit[J/OL]. JBI Evidence Summary. (2017- 07- 20)[2018-08-29]. http://ovidsp.tx.ovid.com/sp-3.33.0b/ovidweb.cgi&S=OJCDFPMOJCDDDGBPNCDKMFGCCJEAAA00&Complete+Reference=S.sh.17%7c3%7c1&Counter5=SS_view_found_complete%7cJBI13573%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI13573%7cjbi%7cjbidb%7cjbi .
[13]	Moola S, Lockwood C . Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment[J]. Int J Evid Based Healthc, 2011,9(4):337-345.
[14]	Torossian A, Bräuer A, Höcker J , et al. Preventing inadvertent perioperative hypothermia[J]. Dtsch Arztebl Int, 2015,112(10):166-172.
[15]	AmericanAssociation for Respiratory Care, RestrepoRD, Walsh BK . Humidification during invasive and noninvasive mechanical ventilation:2012[J]. Respir Care, 2012,57(5):782-788.
[16]	AORNRecommended Practices Committee. Guideline for Prevention of Unplanned PerioperativeHypothermia[EB/OL]. (2015-01-01)[2018-08-29]. https://www.aorn.org/guidelines/clinical-resources/tool-kits/non-member-tool-kits/prevention-of-perioperative-hypothermia-pph-tool-kit-nonmembers.
[17]	国家麻醉专业质量控制中心. 围手术期患者低体温防治专家共识(2017)[J]. 协和医学杂志, 2017,8(6):352-358.
[18]	陈静, 岳丽青, 曹扬 , 等. 有源医疗器械相关不良事件的发生原因分析及建议[J]. 中华护理杂志, 2018,53(11):1363-1366.
[19]	沈蕴之, 蒋红, 黄莺 , 等. 个体化现况-背景-评估-建议沟通模式的临床应用及效果评价[J]. 中华护理杂志, 2014,49(6):688-692.
[20]	徐双燕, 姚梅琪, 周海燕 . 标准化沟通方式在医护间沟通中的应用[J]. 中华护理杂志, 2012,47(1):48-49.
[21]	李全, 巴特, 王凌峰 , 等. 危重烧伤患者围手术期低体温的处理11例[J]. 中华烧伤杂志, 2017,33(8):506-507.
[22]	Power G, Moore Z, O'Connor T. Measurement of pH,exudate composition and temperature in wound healing:a systematic review[J]. J Wound Care, 2017,26(7):381-397.
[23]	周英凤, 胡雁, 顾莺 , 等. 基于证据的持续质量改进模式图的构建[J]. 中国循证医学杂志, 2017,17(5):603-606.
[24]	Rizzo J A, Rowan M P, Driscoll I R,et al. Perioperative temperature management during burn care[J]. J Burn Care Res, 2017,38(1):e277-e283.

项目	例数	复合复温措施执行率	核心体温测量正确率
证据应用前	32	7（21.88）	6（18.75）
证据应用后	36	30（83.33）	35（97.22）
χ²值	例数	25.796	43.576
P 值		<0.001	<0.001

项目	例数	复合复温措施执行率	核心体温测量正确率
证据应用前	32	7（21.88）	6（18.75）
证据应用后	36	30（83.33）	35（97.22）
χ²值	例数	25.796	43.576
P 值		<0.001	<0.001

项目	例数	返回烧伤ICU即刻体温（℃）	低体温持续时间（min）
证据应用前	32	35.16±0.63	274.38±149.43
证据应用后	36	35.21±0.72	107.89±65.39
t值		-1.805	77.604
P值		0.071	0.001

项目	例数	返回烧伤ICU即刻体温（℃）	低体温持续时间（min）
证据应用前	32	35.16±0.63	274.38±149.43
证据应用后	36	35.21±0.72	107.89±65.39
t值		-1.805	77.604
P值		0.071	0.001