Effects of multi-modal temperature intervention measures on perioperative hypothermia in patients undergoing orthotopic liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2017.04.014

Abstract

Abstract:

Objective

To investigate the effects of multi-modal temperature intervention measures on perioperative hypothermia in the patients undergoing orthotopic liver transplantation (LT).

Methods

One hundred and twenty patients who underwent orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2014 and October 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 93 cases were males and 27 were females, aged 31-70 years old with a median age of 55 years old. According to the sequencing of the operation time, the patients were randomly divided into the multi-modal temperature intervention group (multi-modal group, n=63) and regular temperature group (control group, n=57) with the method of computer generated random number. All patients in two groups underwent classical non-bypass orthotopic LT under endotracheal general anesthesia. The temperature, liver and renal function during the perioperative period in two groups were compared using independent sample t test.

Results

The temperature at the anhepatic stage, 4 h of reperfusion stage and postoperative 72 h in the multi-modal group was respectively (34.5±0.7)℃, (35.6±0.7)℃ and (36.2±0.8)℃, significantly higher than (33.6±0.4)℃, (34.7±0.3)℃ and (35.6±0.6)℃ in the control group (t=6.60, 7.24, 18.68; P<0.05). The uring volume at postoperative 8, 16 and 24 h in the multi-modal group was respectively (72±16), (77±20) and (77±22) ml/h, significantly more than (50±14), (52±17) and (60±17) ml/h in the control group (t=9.24, 13.37, 16.79; P<0.05). The serum Scr and PT levels at postoperative 8, 16 and 24 h in the multi-modal group were respectively (80±19), (92±20), (115±21) μmol/L and (17.1±2.5), (17.1±4.0) and (17.1±1.5) s, significantly lower than (99±29), (105±24), (130±25) μmol/L and (22.6±2.8), (21.4±3.2), (19.5±2.3) s in the control group (t=-7.29, -11.97, -15.58 and -23.21, -11.26, -9.83; P<0.05).

Conclusions

For the orthotopic LT patients, multi-modal temperature intervention measures can reduce the incidence of perioperative hypothermia and accelerate the recovery of liver and renal function.

Key words: Liver transplantation, Body temperature, Perioperative care

Xianling Zhang, Zheng Zhang, Gangjian Luo, Hui Luo. Effects of multi-modal temperature intervention measures on perioperative hypothermia in patients undergoing orthotopic liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 298-302.

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Figures/Tables 2

References 20

[1]	唐晖，傅斌生，陈规划．心脏死亡器官捐献肝移植的供体功能维护[J]．器官移植，2016，7(1):21-25.
[2]	谢汉镔，葛缅，池信锦，等．肝移植围手术期缺血-再灌注胃氧化损伤发生机制[J/CD]．中华肝脏外科手术学电子杂志，2015，4(4):254-258.
[3]	于冬男，李鹏，吴群林，等．原位肝移植围术期核心体温变化趋势及应对策略[J]．实用医学杂志，2015，31(12):1974-1977.
[4]	冯腾尘，崔晓光．围术期低体温防治研究进展[J]．中华实用诊断与治疗杂志，2016，30(3):218-221.
[5]	Beedle SE, Phillips A, Wiggins S, et al. Preventing unplanned perioperative hypothermia in children[J]. AORN J, 2017, 105(2):170-183.
[6]	Weinberg L, Huang A, Alban D, et al. Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial[J]. BMC Surgery, 2017, 17(1):1-10.
[7]	Kim GS, Ko JS, Yu JM, et al. The intermittent bolus infusions of rapid infusion system caused hypothermia during liver transplantation[J]. Korean J Anesthesiol, 2013, 65(4):363-364.
[8]	Sessler DI. Perioperative thermoregulation and heat balance[J]. Lancet, 2016, 387(10038): 2655-2664.
[9]	Kwak HJ, Min SK, Yi IK, et al. Comparison of the effects of sevoflurane and propofol on core body temperature during laparoscopic abdominal surgery[J]. Korean J Anesthesiol, 2011, 61(2):133-137.
[10]	Han SB, Gwak MS, Choi SJ, et al. Effect of active airway warming on body core temperature during adult liver transplantation[J]. Transplant Proc, 2013, 45(1):251-254.
[11]	Wetz AJ, Perl T, Brandes IF, et al. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients[J]. J Clin Anesth, 2016(34):282-289.
[12]	Shaw CA, Steelman VM, DeBerg J, et al. Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: a systematic review and meta-analysis of randomized controlled trials[J]. J Clin Anesth, 2017(38):93-104.
[13]	Rightmyer J, Singbartl K. Preventing perioperative hypothermia[J]. Nursing, 2016, 46(9):57-60.
[14]	王桂红，陈荣珠，肝脏手术术中低体温的原因分析及护理进展[J]. 临床护理杂志，2012，11(4):53-56.
[15]	Madrid E, Urrútia G, Roquéi Figuls M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J]. Cochrane Database Syst Rev, 2016(4):CD009016.
[16]	Forbes SS, McLean RF. Review article: the anesthesiologist's role in the prevention of surgical site infections[J]. Can J Anaesth, 2013, 60(2):176-183.
[17]	Frisch NB, Pepper AM, Rooney E, et al. Intraoperative hypothermia in total hip and knee arthroplasty[J]. Orthopedics, 2017, 40(1):56-63.
[18]	Horosz B, Nawrocka K, Malec-Milewska M. Anaesthetic perioperative management according to the ERAS protocol[J]. Anaesthesiol Intensive Ther, 2016, 48(1):49-54.
[19]	Moro ET, Leme FC, Noronha BR, et al. Quality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. prospective randomized clinical trial[J]. J Clin Anesth, 2016(35):369-375.
[20]	代永静，王建荣，马燕兰，等．液体温度对双侧人工关节置换患者术中肾功能的影响[J]．护理学杂志，2010, 25(2):49-51.

组别	例数	麻醉前	手术时间		无肝期	新肝期
组别	例数	麻醉前	1 h	2 h	无肝期	早期	2 h	4 h
多模式组	63	36.1±0.7	35.6±0.7	35.4±0.8	34.5±0.7	34.1±0.3	35.0±0.7	35.6±0.7
对照组	57	36.2±0.6	35.5±0.4	35.0±0.5	33.6±0.4	33.2±0.2	34.5±0.6	34.7±0.3
t	?	-0.35	4.63	1.12	6.60	7.61	6.14	7.24
P	?	>0.05	>0.050	>0.050	<0.050	<0.050	<0.050	<0.050
组别	例数	术毕	术后时间点
组别	例数	术毕	8 h	24 h	48 h	72 h
多模式组	63	35.7±0.9	36.0±0.7	35.9±0.3	36.2±0.3	36.2±0.8
对照组	57	34.8±0.8	35.4±1.0	35.2±0.6	35.4±0.6	35.6±0.6
t	?	5.03	7.58	5.63	9.37	18.68
P	?	<0.050	<0.050	<0.050	<0.050	<0.05

组别	例数	麻醉前	手术时间		无肝期	新肝期
组别	例数	麻醉前	1 h	2 h	无肝期	早期	2 h	4 h
多模式组	63	36.1±0.7	35.6±0.7	35.4±0.8	34.5±0.7	34.1±0.3	35.0±0.7	35.6±0.7
对照组	57	36.2±0.6	35.5±0.4	35.0±0.5	33.6±0.4	33.2±0.2	34.5±0.6	34.7±0.3
t	?	-0.35	4.63	1.12	6.60	7.61	6.14	7.24
P	?	>0.05	>0.050	>0.050	<0.050	<0.050	<0.050	<0.050
组别	例数	术毕	术后时间点
组别	例数	术毕	8 h	24 h	48 h	72 h
多模式组	63	35.7±0.9	36.0±0.7	35.9±0.3	36.2±0.3	36.2±0.8
对照组	57	34.8±0.8	35.4±1.0	35.2±0.6	35.4±0.6	35.6±0.6
t	?	5.03	7.58	5.63	9.37	18.68
P	?	<0.050	<0.050	<0.050	<0.050	<0.05

术后时间点(h)	AST（U/L）		ALT（U/L）		BUN（mmol/L）		Scr（μmol/L）
术后时间点(h)	多模式组	对照组	多模式组	对照组	多模式组	对照组	多模式组	对照组
8	0714±107	724±89	510±96	520±102	5.7±0.7	5.4±1.0	080±19^a	099±29
16	569±69	575±48	471±70	472±870	9.7±1.4	9.5±1.7	092±20^a	105±24
24	464±94	480±37	425±53	465±740	9.7±2.2	9.3±1.9	115±21^a	130±25
48	245±47	243±49	209±28	216±330	14.6±3.30	15.2±2.50	144±18^a	146±19
72	180±43	186±30	141±36	145±300	23.4±3.30	22.8±4.70	175±21^a	173±15
术后时间点(h)	PT（s）		APTT（s）		尿量（ml/h）
术后时间点(h)	多模式组	对照组	多模式组	对照组	多模式组	对照组
8	17.1±2.5^a	22.6±2.8	52±8	050±10	72±16^a	50±14
16	17.1±4.0^a	21.4±3.2	46±8	47±8	77±20^a	52±17
24	17.1±1.5^a	19.5±2.3	39±4	40±5	77±22^a	60±17
48	15.6±1.7^a	16.5±2.3	034±10	35±4	80±21^a	80±26
72	15.5±1.6^a	15.8±2.1	34±6	34±4	823±130^a	81±25

术后时间点(h)	AST（U/L）		ALT（U/L）		BUN（mmol/L）		Scr（μmol/L）
术后时间点(h)	多模式组	对照组	多模式组	对照组	多模式组	对照组	多模式组	对照组
8	0714±107	724±89	510±96	520±102	5.7±0.7	5.4±1.0	080±19^a	099±29
16	569±69	575±48	471±70	472±870	9.7±1.4	9.5±1.7	092±20^a	105±24
24	464±94	480±37	425±53	465±740	9.7±2.2	9.3±1.9	115±21^a	130±25
48	245±47	243±49	209±28	216±330	14.6±3.30	15.2±2.50	144±18^a	146±19
72	180±43	186±30	141±36	145±300	23.4±3.30	22.8±4.70	175±21^a	173±15
术后时间点(h)	PT（s）		APTT（s）		尿量（ml/h）
术后时间点(h)	多模式组	对照组	多模式组	对照组	多模式组	对照组
8	17.1±2.5^a	22.6±2.8	52±8	050±10	72±16^a	50±14
16	17.1±4.0^a	21.4±3.2	46±8	47±8	77±20^a	52±17
24	17.1±1.5^a	19.5±2.3	39±4	40±5	77±22^a	60±17
48	15.6±1.7^a	16.5±2.3	034±10	35±4	80±21^a	80±26
72	15.5±1.6^a	15.8±2.1	34±6	34±4	823±130^a	81±25

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