手術(shù)病人術(shù)中低體溫的預(yù)防與護(hù)理

手術(shù)病人術(shù)中低體溫的預(yù)防與護(hù)理Utwisienimadminimveniam

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ipsumdolorsitamet,consectetueradipiscing匯報(bào)人：當(dāng)小圖YOURLOGO手術(shù)病人術(shù)中低體溫的預(yù)防與護(hù)理Utwisienimadminimveniam

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ipsumdolorsitamet,consectetueradipiscing匯報(bào)人：當(dāng)小圖YOURLOGOPART01低體溫影響的原因Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

低體溫人體正常的體核溫度介于36℃至38℃之間。雖然低體溫被定義為體核溫度小于36℃，但是它可分為輕度、中度、重度這三個等級：1、輕度低體溫是指介于34℃至35℃之間的體核溫度。2、中度低體溫是指介于30℃至34℃之間的體核溫度。3、嚴(yán)重低體溫是指低于30℃的體核溫度。1、低溫環(huán)境環(huán)境溫度較高，體溫略高，反之體溫略低。如果環(huán)境體溫太低，則可造成體溫過低。通常情況下，手術(shù)間應(yīng)該保持室溫22~24攝氏度，手術(shù)間相對濕度在40%~60%。低體溫影響的原因2、大量輸液輸血由于手術(shù)時間長，術(shù)中出血較多，需要通過靜脈通道大量的輸入庫血和液體，可達(dá)每分鐘100~200ml，若加壓可達(dá)500~600ml。大量的、快速的冷液體進(jìn)入病人體內(nèi)，可導(dǎo)致低體溫的加重。低體溫影響的原因3、大量的沖洗在施行胸（腹）腔大手術(shù)時，體內(nèi)臟器及切口直接暴露于環(huán)境溫度下，術(shù)中用大量的未加溫的鹽水沖洗體腔，導(dǎo)致機(jī)體熱量散失，并且覆蓋在病人身體上的被單在沖洗時浸濕，進(jìn)一步導(dǎo)致熱量的散失。低體溫影響的原因PART02低體溫的危害Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

1、血液系統(tǒng)的改變體溫下降可出現(xiàn)多方面的血液系統(tǒng)異常，其中較為重要的是凝血障礙，導(dǎo)致極差的預(yù)后。低體溫主要是通過對凝血酶和血小板的影響引起凝血功能障礙。低體溫的危害2、心血管功能改變輕度低體溫時交感神經(jīng)興奮，心率加快，心肌收縮力增強(qiáng)，心輸出量增加，外周血管收縮。外周阻力增加和血液黏稠度升高，會增加心臟做功，可能導(dǎo)致心肌缺血和心律失常。低體溫的危害3、代謝紊亂低體溫可降低代謝率和氧的供給，體溫每降低1攝氏度，約降低機(jī)體需氧量7%。盡管低體溫時人體可通過降低機(jī)體代謝率減少對氧的需求，但低體溫引起的氧傳送功能的下降可導(dǎo)致機(jī)體嚴(yán)重缺氧，可引起代謝性酸中毒。低體溫的危害4、對中樞神經(jīng)系統(tǒng)的影響低溫對中樞神經(jīng)系統(tǒng)的影響極其明顯，輕度出現(xiàn)意識錯亂，進(jìn)而出現(xiàn)淡漠、判斷障礙、異常行為，嚴(yán)重出現(xiàn)意識障礙，甚至昏迷。低體溫的危害PART03溫度檢測設(shè)備建議Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

肺動脈導(dǎo)管探頭（PAC）－黃金標(biāo)準(zhǔn)不建議：腋窩溫度計(jì)紅外溫度計(jì)推薦：食管溫度計(jì)探頭留置尿?qū)Ч軠囟忍筋^口內(nèi)溫度計(jì)溫度檢測設(shè)備建議PART04預(yù)防低體溫的護(hù)理措施Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

1、加強(qiáng)手術(shù)過程中對病人體溫檢測經(jīng)常觀察病人的皮膚、溫度及面色，并及時測體溫。對于低體溫病人要及時采取措施。預(yù)防低體溫的護(hù)理措施2、術(shù)中保溫措施a/控制室溫手術(shù)室采用空氣層流系統(tǒng)，保持室溫22~24攝氏度，相對濕度在40~60%。預(yù)防低體溫的護(hù)理措施b/輸入加熱的體液液體加熱后輸入不僅能有效的減輕低體溫，從某種意義上有一定的升溫作用，是復(fù)溫常用的方法。靜脈輸注的液體或血液加溫至36攝氏度左右，血液加熱溫度不能過高，否則會引起血細(xì)胞破壞。預(yù)防低體溫的護(hù)理措施

c/溫鹽水沖洗術(shù)中沖洗液加溫至體溫水平，以保持病人體溫的恒定預(yù)防低體溫的護(hù)理措施d/采用保暖物品（1）保暖棉被服：不實(shí)施手術(shù)部位用保暖性能好的被服或手術(shù)巾遮蓋，使之與周圍的冷空氣隔絕，盡量避免弄濕被服，保持手術(shù)床的干燥。預(yù)防低體溫的護(hù)理措施預(yù)防低體溫的護(hù)理措施d/采用保暖物品（2）熱水袋：袋內(nèi)加熱水1/3~1/2滿，溫度50攝氏度以內(nèi)，并以多層包裹，至于病人的四肢及輸液處，使熱不直接接觸肢體。預(yù)防低體溫的護(hù)理措施e/呼吸道的加熱熱化氣體，利用呼吸蒸發(fā)器加熱吸入氧氣，預(yù)防呼吸道散熱，可減少深部溫度繼續(xù)下降。在全麻病人中應(yīng)用濕熱交換器能保持呼吸道內(nèi)恒定溫度和濕度。f/心理疏導(dǎo)加強(qiáng)手術(shù)前心理疏導(dǎo)，有助于預(yù)防低體溫。認(rèn)真做好術(shù)前術(shù)后訪視，訪視時面對面交流，可消除病人對手術(shù)室和工作人員的陌生感，緩解病人的焦慮情緒，減輕病人因?yàn)榫褚蛩貙?dǎo)致對冷刺激的閾值下降。

預(yù)防低體溫的護(hù)理措施其他手術(shù)前應(yīng)安排好工作人員，密切配合，使麻醉時間，手術(shù)時間，創(chuàng)面暴露時間盡量縮短，另外，護(hù)送病人回病室要加蓋被褥，注意保暖，特別是冬季。PART05總結(jié)Loveisalamp,whilefriendshipistheshadow.Whenthelampisoff,youwillfindtheshadoweverywhere.Friendiswhocangiveyoustrengthatlast.

在外科手術(shù)過程中低溫的發(fā)生率為50%~70%。術(shù)中低體溫現(xiàn)象已經(jīng)引起臨床醫(yī)護(hù)人員的重視?？偨Y(jié)醫(yī)院手術(shù)室護(hù)理工作，是醫(yī)療質(zhì)量的重要構(gòu)成部分之一，手術(shù)室作為手術(shù)治療與搶救的重要場所，其護(hù)理工作的質(zhì)量高低直接決定著病人手術(shù)成功與否以及性命安危。高質(zhì)量的護(hù)理工作，不僅可以確保醫(yī)療質(zhì)量，而且能夠達(dá)到患者滿意的基本保證。

運(yùn)用護(hù)理手段不僅能有效干預(yù)術(shù)中低體溫的發(fā)生，而且方法簡單、易行。始于在臨床廣泛推廣，同時也能提高了手術(shù)室護(hù)理質(zhì)量，深化了護(hù)理內(nèi)涵，更好的服務(wù)于病人。總結(jié)手術(shù)病人術(shù)中低體溫的預(yù)防與護(hù)理Utwisienimadminimveniam

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