手术病人术中低体温的预防与护理

手术病人术中低体温的预防与护理Utwisienimadminimveniam

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ipsumdolorsitamet,consectetueradipiscing汇报人：当小图YOURLOGO手术病人术中低体温的预防与护理Utwisienimadminimveniam

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ipsumdolorsitamet,consectetueradipiscing汇报人：当小图YOURLOGOPART01低体温影响的原因Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

低体温人体正常的体核温度介于36℃至38℃之间。虽然低体温被定义为体核温度小于36℃，但是它可分为轻度、中度、重度这三个等级：1、轻度低体温是指介于34℃至35℃之间的体核温度。2、中度低体温是指介于30℃至34℃之间的体核温度。3、严重低体温是指低于30℃的体核温度。1、低温环境环境温度较高，体温略高，反之体温略低。如果环境体温太低，则可造成体温过低。通常情况下，手术间应该保持室温22~24摄氏度，手术间相对湿度在40%~60%。低体温影响的原因2、大量输液输血由于手术时间长，术中出血较多，需要通过静脉通道大量的输入库血和液体，可达每分钟100~200ml，若加压可达500~600ml。大量的、快速的冷液体进入病人体内，可导致低体温的加重。低体温影响的原因3、大量的冲洗在施行胸（腹）腔大手术时，体内脏器及切口直接暴露于环境温度下，术中用大量的未加温的盐水冲洗体腔，导致机体热量散失，并且覆盖在病人身体上的被单在冲洗时浸湿，进一步导致热量的散失。低体温影响的原因PART02低体温的危害Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

1、血液系统的改变体温下降可出现多方面的血液系统异常，其中较为重要的是凝血障碍，导致极差的预后。低体温主要是通过对凝血酶和血小板的影响引起凝血功能障碍。低体温的危害2、心血管功能改变轻度低体温时交感神经兴奋，心率加快，心肌收缩力增强，心输出量增加，外周血管收缩。外周阻力增加和血液黏稠度升高，会增加心脏做功，可能导致心肌缺血和心律失常。低体温的危害3、代谢紊乱低体温可降低代谢率和氧的供给，体温每降低1摄氏度，约降低机体需氧量7%。尽管低体温时人体可通过降低机体代谢率减少对氧的需求，但低体温引起的氧传送功能的下降可导致机体严重缺氧，可引起代谢性酸中毒。低体温的危害4、对中枢神经系统的影响低温对中枢神经系统的影响极其明显，轻度出现意识错乱，进而出现淡漠、判断障碍、异常行为，严重出现意识障碍，甚至昏迷。低体温的危害PART03温度检测设备建议Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

肺动脉导管探头（PAC）－黄金标准不建议：腋窝温度计红外温度计推荐：食管温度计探头留置尿导管温度探头口内温度计温度检测设备建议PART04预防低体温的护理措施Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

1、加强手术过程中对病人体温检测经常观察病人的皮肤、温度及面色，并及时测体温。对于低体温病人要及时采取措施。预防低体温的护理措施2、术中保温措施a/控制室温手术室采用空气层流系统，保持室温22~24摄氏度，相对湿度在40~60%。预防低体温的护理措施b/输入加热的体液液体加热后输入不仅能有效的减轻低体温，从某种意义上有一定的升温作用，是复温常用的方法。静脉输注的液体或血液加温至36摄氏度左右，血液加热温度不能过高，否则会引起血细胞破坏。预防低体温的护理措施

c/温盐水冲洗术中冲洗液加温至体温水平，以保持病人体温的恒定预防低体温的护理措施d/采用保暖物品（1）保暖棉被服：不实施手术部位用保暖性能好的被服或手术巾遮盖，使之与周围的冷空气隔绝，尽量避免弄湿被服，保持手术床的干燥。预防低体温的护理措施预防低体温的护理措施d/采用保暖物品（2）热水袋：袋内加热水1/3~1/2满，温度50摄氏度以内，并以多层包裹，至于病人的四肢及输液处，使热不直接接触肢体。预防低体温的护理措施e/呼吸道的加热热化气体，利用呼吸蒸发器加热吸入氧气，预防呼吸道散热，可减少深部温度继续下降。在全麻病人中应用湿热交换器能保持呼吸道内恒定温度和湿度。f/心理疏导加强手术前心理疏导，有助于预防低体温。认真做好术前术后访视，访视时面对面交流，可消除病人对手术室和工作人员的陌生感，缓解病人的焦虑情绪，减轻病人因为精神因素导致对冷刺激的阈值下降。

预防低体温的护理措施其他手术前应安排好工作人员，密切配合，使麻醉时间，手术时间，创面暴露时间尽量缩短，另外，护送病人回病室要加盖被褥，注意保暖，特别是冬季。PART05总结Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

在外科手术过程中低温的发生率为50%~70%。术中低体温现象已经引起临床医护人员的重视。总结医院手术室护理工作，是医疗质量的重要构成部分之一，手术室作为手术治疗与抢救的重要场所，其护理工作的质量高低直接决定着病人手术成功与否以及性命安危。高质量的护理工作，不仅可以确保医疗质量，而且能够达到患者满意的基本保证。

运用护理手段不仅能有效干预术中低体温的发生，而且方法简单、易行。始于在临床广泛推广，同时也能提高了手术室护理质量，深化了护理内涵，更好的服务于病人。总结手术病人术中低体温的预防与护理Utwisienimadminimveniam

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