[罂粟摘要]腰麻下全膝关节置换术中的自热毯与压力暖风毯的比较：一项随机非劣效性试验

腰麻下全膝关节置换术中的自热毯与压力暖风毯的比较：一项随机非劣效性试验

贵州医科大学麻醉与心脏电生理课题组

翻译: 马艳燕

编辑: 严旭 

审校: 曹莹

背景：关节置换术患者发生体温过低的风险很高。用压力暖风毯预热已被证明可以降低术中体温过低的发生率。然而，缺乏证据表明使用自热(SW)毯进行预热可以降低围手术期低体温的发生率。本研究旨在评估围手术期SW毯和压力暖风(FAW)毯的保暖效果。我们假设SW毯的保暖性比FAW毯差。

方法：总共有150名计划在腰麻下进行首次单侧全膝关节置换术的患者被随机纳入到这项前瞻性研究。在腰麻诱导前，患者用SW毯（SW组）或FAW毯（FAW组）进行预热，设置温度为38℃预热30分钟。使用手术室里用分配的毯子帮助继续保暖。如果核心温度降至36℃以下，则使用设置为43℃的FAW毯子对所有患者进行保暖。并连续监测核心和体表温度。主要结果是进入恢复室时的核心温度。

结果：两种方法在预热期间都提高了平均体温。然而，SW组61%的患者发生术中低体温，FAW组49%的患者发生术中低体温。将FAW方法温度设置为43℃可以使体温过低的患者复温。进入恢复室时两组之间的核心温度没有差异(p=0.366,CI：-0.18–0.06)。

结论：从统计学上看，SW毯并不逊色于FAW毯。然而，SW组的体温过低更为常见，因为我们严格遵守NICE指南，因此需要急救升温。

原始文献来源  ：Lauronen SL, Kalliovalkama J, Aho A, Mäkinen MT, Huhtala H, Yli-Hankala AM, Kalliomäki ML. Self-warming blanket versus forced-air warming blanket during total knee arthroplasty under spinal anaesthesia: A randomised non-inferiority trial. Acta Anaesthesiol Scand. 2023 May 28. doi: 10.1111/aas.14283. 

英文原文：

Self-warming blanket versus forced-air warming blanket during total knee arthroplasty under spinal anaesthesia: A randomised non-inferiority trial

Background: Arthroplasty patients are at high risk of hypothermia. Pre-warming with forced air has been shown to reduce the incidence of intraoperative hypothermia. There is, however, a lack of evidence that pre-warming with a self-warming (SW) blanket can reduce the incidence of perioperative hypothermia. This study aims to evaluate the effectiveness of an SW blanket and a forced-air warming (FAW) blanket peri-operatively. We hypothesised that the SW blanket is inferior to the FAW blanket.

Methods: In total, 150 patients scheduled for primary unilateral total knee arthroplasty under spinal anaesthesia were randomised to this prospective study. Patients were pre-warmed with SW blanket (SW group) or upper-body FAW blanket (FAW group) set to 38°C for 30 min before spinal anaesthesia induction. Active warming was continued with the allocated blanket in the operating room. If core temperature fell below 36°C, all patients were warmed using the FAW blanket set to 43°C. Core and skin temperatures were measured continuously. The primary outcome was core temperature on admission to the recovery room.

Results: Both methods increased mean body temperature during pre-warming. However, intraoperative hypothermia occurred in 61% of patients in the SW group and in 49% in the FAW group. The FAW method set to 43°C could rewarm hypothermic patients. Core temperature did not differ between groups on admission to the recovery room, p = .366 (CI: -0.18-0.06).

Conclusion: Statistically, the SW blanket was non-inferior to the FAW method. Yet, hypothermia was more frequent in the SW group, requiring rescue warming as we strictly held to the NICE guideline.

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