The Study Of Different Heat Preservation Interventions In Maintaining Normothermia In Patients Undergoing Open Abdominal Surgery

Objectives1To investigate the effects of using normal heating blanket, inflatable heating blanket or comprehensive heat preservation measurement in open abdominal surgery to maintain patient body temperature.2To examine the disparities between low body temperature patients and control groups in recovery time, hospital stays and cost.Methods1The participants (n=90) undergoing open abdominal surgery were recruited from Tianjin First Central Hospital admitted from November2011to June2012. The selected patients were divided into three groups. Three different warming methods were applied to each group:group Ⅰ, normal heating blanket, group Ⅱ, inflatable heating blanket and group Ⅲ, comprehensive heat preservation procedures in which normal heating blanket was also used, in addition, patients’ head and extremities were covered with cotton blanket.2Qualified samples:①Ⅰ Ⅱ or Ⅲ ASA level;②normal preoperational body temperature:the average body temperature is between36.5±0.5℃, day1preoperational in floors, no fever or hypothermia presentation;③in general anesthesia;④in supine position, and intra-op performance is not through anus, done better for stabilization of temperature monitor tip insertion in anus;⑤no post-op complications, such as excessive intra-operational bleeding;⑥elevated ability to sustain temperature monitor tip through anus, and follow up legal inform which helpful in better cooperation with them.3Unqualified samples:①case of hypothermia or hyperthermia patient as of intervention for thermal maintaining or increasing thermoregulation;②case of change operational strategy randomly as of the diagnostic disparities in intra-operational or post-op.③case of taking antipsychotic drugs or beta blockers before surgery which will have impact of intraoperative temperature.4Based on ages, gender, weight, and surgical procedures (age is+/-5years, same gender, body weight is+/-5Kg and similar surgical procedures), randomly allocate eligible participants into three treatment groups,30patients in a group,90patients in total.5In group Ⅰ, patients were heated with standard heating blanket and covered with sterile drone. The abdominal wash solution was kept at room temperature.The standard heating blankets with a maximum temperature setting at42℃and the minimum setting at38℃are made by Tianjin Akefu Technology, Ltd (model SHWT-A). In group II, patients are covered with inflatable thermal blanket (Bair hugger750controller and525blanket with a high temperature setting at43℃, medium setting at38℃, low setting at32℃). Patients’head and the extremity received IV fluid were covered with cloth pad. The abdominal wash solution, which helps heat transferring to the abdominal organs, is preheated to40-42℃, was left in the peritoneum for3min and removed by aspiration. In group III, patients were also heated with standard heating blanket. In addition, patients’head and extremities were wrapped up with cloth pad for heat preservation. The abdominal wash solution, which helps heat transferring to the abdominal organs, is preheated to40-42℃, was left in the peritoneum for3min and removed by aspiration. All heating devices are warmed up for30mins before usage. During the operation, patients lower extremities were covered with heating blankets and they will not be removed until patients completely wake up and in stable condition.6The outcome landmark is recorded by rectal temperature, which measured from admission to post anesthesia Q30mins, until the end of the op, recovery length, hospital days and cost.7Statistic method. Collected data were analyzed with SPSS16statistic software. A significance is defined as P<0.05. The differences among each groups were determined with Pearson’s chi-square tests and Fisher’s exact tests.Results1. When we compared body temperatures of open abdominal surgery patients who receiving three different warming methods, there is no significance among three groups in120minutes, however, significance were observed when operation is longer than120mins. Significant different was observed between group I (normal heating blanket) and group II (inflatable heating blanket) or between group I and III (comprehensive heat preservation). There is no statistically difference between group II and III.2.10out of30patients in group I showed hypothermia, but none was observed in other two groups. The difference is statistically significant.3. There are significant differences between hypothermia patients and control group in recovery length, hospital stay and costs. Conclusions1The effect of standard heating blanket in abdominal surgery is not as effective as those of inflatable heating blanket and comprehensive heat preservation. However, in short surgeries which last less120mins, the usage of standard heating blanket is sufficient for normothermia and could reduce the workload and the medical cost.2When surgeries last longer than120mins, both inflatable heating blanket and comprehensive heat preservation could effectively prevent the occurrence of intra operative hypothermia. Since the inflatable heating blankets are more expensive than comprehensive heat preservation, the usage of comprehensive heat preservation could decreases medical spending.3In comparison of control patients, hypothermia patients are subjected to long recovery time, more hospital stay, and higher medical cost. Maintaining normothermia in patients undergoing open abdominal surgery will not only bring medical benefits to patients, but also save medical cost for both patients and society.