产科麻醉中使用可吸收遥测传感器监测核心温度

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Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor

背景

围产期低温可影响产科椎管内麻醉后产妇及新生儿的结局。由于缺乏精确的无创核心温度监测仪,椎管内麻醉期间核心温度常常监测不佳。本研究的目的是描述剖宫产椎管内麻醉期间的核心温度变化和温度恢复情况。我们预测产科椎管内麻醉与临床相关的体温调节性损伤(核心温度下降﹥1.0℃)有关。

方  法

对28名产妇进行了描述性研究。使用可吸收遥测传感器来记录核心温度随时间的变化(每10秒测一次)。主要结果为椎管内麻醉后最大核心温度下降值,次要结果是最低绝对核心温度,达到最低温度的时间及中心温度回复时间,低温暴露时间(﹤37.0℃)和时间加权低温暴露(中位数﹤37.0℃)。利用温度-时间曲线37.0℃以下区域的面积和中位积分进行描述性统计及分析数据。

结  果

肠道温度平均下降1.30℃:标准差(SD)=0.31,99%置信区间(CI)=1.14~1.46;达到最低温度时间中位数(IQR)=0.96h(0.73~1.32):95%置信区间=0.88~1.22;28名参与者中有14人在椎管内麻醉后肠内温度低于36.0℃,麻醉后温度监测至少8h。8人肠道温度在监测期间未恢复到基线水平,其余20名产妇,恢复到基线水平肠道温度的中位时间(IQR)为4.95小时(95%置信区间=3.45~5.90);参与者中低温暴露的中位时间为1.97小时(1.00~2.68;95%置信区间=1.23~2.45);低于37.0℃/小时的中为时间为0.45(0.35~0.60;95%置信区间=0.36~0.58)。

结  论

椎管内麻醉剖宫产期间,产妇核心温度迅速下降。使用肠道遥测传感器,高分辨率记录围术期热损伤和恢复。本研究中50%患者出现低温情况。尽管外科手术时间通常较短,但于椎管内麻醉下行剖宫产的产妇经历显著的的低温暴露和几个小时的体温调节受损。

原始文献摘要

du Toit, Leonvan Dyk, DominiqueHofmeyr, RossLombard, Carl J.Dyer, Robert A;Anesthesia & Analgesiadoi:10.1213/ANE.0000000000002326;Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor;

Abstract

Perioperative hypothermia may affect maternal and neonatal outcomes after obstetric spinal anesthesia. Core temperature is often poorly monitored during spinal anesthesia,due to the lack of an accurate noninvasive core temperature monitor. The aim of this study was to describe core temperature changes and temperature recovery during spinal anesthesia for elective cesarean delivery. We expected that obstetric spinal anesthesia would be associated with a clinically relevant thermoregulatory insult (core temperature decrease >1.0°C).

METHODS: A descriptive study was conducted in 28 women. An ingestible telemetric temperature sensor was used to record core temperature over time (measured every 10 seconds). The

primary outcome was the maximum core temperature decrease after spinal anesthetic injection.The secondary outcomes were lowest absolute core temperature, time to lowest temperature,time to recovery of core temperature, hypothermic exposure (degree-hours below 37.0°C),and the time-weighted hypothermic exposure (median number of degrees below 37.0°C per hour). Basic descriptive statistics, median spline smooth, and integration of the area below the 37.0°C line of the temperature-over-time curve were utilized to analyze the data.

RESULTS: Intestinal temperature decreased by a mean (standard deviation) of 1.30°C (0.31);99% confidence interval (CI), 1.14 to 1.46 after spinal anesthetic injection. The median (interquartile range [IQR]) time to temperature nadir was 0.96 (0.73–1.32) hours (95% CI, 0.88–1.22). Fourteen of the 28 participants experienced intestinal temperatures below 36.0°C after spinal injection. Temperature was monitored for a minimum of 8 hours after spinal injection. In 8 of 28 participants, intestinal temperature did not recover to baseline during the monitored period. A median (IQR) of 4.59 (3.38–5.92) hours (95% CI, 3.45–5.90) was required for recovery to baseline intestinal temperature in the remaining 20 patients. Participants experienced a median (IQR) of 1.97 (1.00–2.68) degree-hours of hypothermic exposure (95% CI, 1.23–2.45). The median (IQR) number of degrees below 37.0°C per hour was 0.45 (0.35–0.60) (95% CI, 0.36–0.58).

CONCLUSIONS: During cesarean delivery under spinal anesthesia, women experienced a rapid decrease in core temperature. Using an intestinal telemetric sensor, the perioperative thermal

insult and recovery were documented with high resolution. Fifty percent of participants in this study became hypothermic. Although the surgical procedure is typically of short duration, women undergoing spinal anesthesia for cesarean delivery experience significant hypothermic exposure and compromised thermoregulation for several hours.

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