Evidence-based practice of preventive measures for inadvertent perioperative hypothermia in patients undergoing off-pump coronary artery bypass grafting
10.3760/cma.j.cn115682-20211119-05207
- VernacularTitle:非体外循环冠脉搭桥患者术中非计划性低体温预防措施的循证实践
- Author:
Mengtian WANG
1
;
Bin TONG
;
Xiaoming WANG
;
Jun XU
;
Qikai TAN
Author Information
1. 浙江省人民医院/杭州医学院附属人民医院手术室，杭州 310014
- Keywords:
Coronary artery bypass, off-pump;
Inadvertent perioperative hypothermia;
Prevention;
Intraoperative heat preservation;
Evidence-based nursing
- From:
Chinese Journal of Modern Nursing
2022;28(25):3394-3404
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish the best preventive measures for inadvertent perioperative hypothermia (IPH) in patients undergoing off-pump coronary artery bypass grafting (OPCABG) based on evidence, in order to reduce the incidence of IPH and reduce various complications in OPCABG patients.Methods:The evidence of preventive measures for IPH in OPCABG patients was systematically searched in major databases at home and abroad. The retrieval time limit was from the establishment of the database to August 31, 2019. Three researchers independently screened and evaluated the literature to obtain the best evidence for the prevention of IPH in patients with OPCABG. Using the cluster sampling method, 29 patients who underwent OPCABG in Zhejiang Provincial People's Hospital from January to April 2020 were selected as the control group, while 27 patients who underwent OPCABG from January to April 2021 were selected as the observation group. The differences in body temperature at admission, body temperature at 1 hour after anesthesia, body temperature after leaving the department, minimum intraoperative body temperature, drainage volume in the first 24 hours after surgery, length of stay in ICU and length of hospital stay after surgery were compared between the two groups.Results:A total of 17 papers were included, and 20 pieces of relevant evidence were obtained. After evaluation by experts, the best evidence suitable for the research environment was selected and applied in clinical practice. The body temperatures at admission of patients in the control group and the observation group were respectively (36.62±0.30) ℃ and (36.49±0.28) ℃, and the difference was not statistically significant ( t=2.85, P>0.05) . The body temperature at 1 h after anesthesia, the body temperature after leaving the department and the lowest body temperature during operation were (35.83±0.30) , (36.04±0.49) and (35.50±0.31) ℃ in the control group, and (36.43±0.38) , (36.62±0.27) and (36.21±0.28) ℃ in the observation group, respectively. The difference between the two groups were statistically significant ( t=37.65, 23.76, 58.13; P<0.01) . The incidence of IPH was 93.1% (27/29) in the control group and 11.1% (3/27) in the observation group, and the difference was statistically significant (χ 2=34.568, P<0.01) . The drainage volume in the first 24 h after operation in the control group was (260.0±70.3) ml and that in the observation group was (212.1±44.3) ml, and the difference between the two groups was statistically significant ( t=-3.025, P<0.01) . The length of ICU stay and hospital stay in the control group were respectively (49.0±13.4) h and (12.2±3.5) d, while those in the observation group were (39.8±13.8) h and (10.5±2.5) d, and the differences between the two groups were statistically significant ( t=-2.524, -2.035; P<0.05) . Conclusions:The best preventive measures for inadvertent perioperative hypothermia in patients with OPCABG provide scientific and rigorous procedures and specifications for the prevention of inadvertent perioperative hypothermia in this type of surgery, effectively reducing the incidence of inadvertent perioperative hypothermia and maintaining the intraoperative core temperature stability of patients, reduce postoperative bleeding and shorten the length of ICU stay and hospital stay, which is worthy of clinical promotion.
