非藥物措施對手術病人低體溫寒顫之改善成效

Effectiveness of Nonpharmaceutical Intervention in Alleviating Hypothermia and Chills in Surgical Patients: A Systematic Review and Meta-analysis

洪曉佩(Shiao-Pei Hong) ； 方韻芝(Yun-Jhih Fong) ； 蘇惠文(Hui-Wen Su) ； 曾麗華(Li-Hua Tseng) ； 許鈺絹(Yu-Chuan Hsu) ； 陳怡君(I-Chun Chen) ； 明金蓮(Jin-Lain Ming)

《醫院雜誌》 55卷2期 (2022/06) Pp. 11-27

摘要

背景：低體溫是手術病人常見問題，一旦發生體溫偏低時將可能導致術後合併症的增加。目的：藉由系統性文獻回顧及統合分析，檢視非藥物介入措施—主動式加溫系統（Active warming systems）對手術病人低體溫改善之成效。方法：於華藝中文電子期刊資料庫、Cochrane Library/Trials、PubMed、CINHAL、MEDLINE等資料庫設定關鍵字，搜尋2016年1月1日至2020年04月17日以前出版之中、英文文獻，依據納入及排除條件，排除不符合此研究主題之文獻後共納入12篇文獻，依據考科藍偏差風險的評估（Cochrane ＂Risk of Bias Tool 2.0＂）之評析標準進行文獻品質評價。統合分析（Meta-Analysis）使用Review Manager軟體（RevMen）5.3版本。結果：統合分析結果顯示：非藥物介入措施對改善手術結束至恢復室時平均體溫之效果量SMD（Standardized Mean Difference）為0.54（95%CI信賴區間：0.33∼0.75，異質性I^2:51%;p=.05）；改善手術全期低體溫發生率之效果量為0.54（95%CI信賴區間：0.45∼0.65，異質性I^2=36%;p=.17）。結論：非藥物介入措施對手術結束至恢復室之低體溫情形及降低手術全期低體溫發生率具有顯著效果，期望藉此於研究之結果提供臨床實務運用，以增進病人之照護品質。

關鍵字

非藥物介入措施 ； 手術 ； 低體溫 ； 寒顫

並列摘要

Background: Postoperative hypothermia is a frequent occurrence in surgical patients, leading to an increase in postoperative complications. Purpose: This systematic review and meta-analysis evaluated the effect of a nonpharmaceutical intervention, namely active warming systems, in alleviating surgical patients' hypothermia. Methods: We used identified keywords to perform a search of Airiti Library, the Cochrane Library, PubMed, CINAHL, and MEDLINE for relevant studies in English and Chinese languages published between January 1, 2016, and April 17, 2020. Literature search results were screened using proposed inclusion and exclusion criteria. Twelve articles were included in the systematic review after the removal of articles with irrelevant topics. Study quality was assessed on the basis of the Cochrane risk-of-bias tool 2.0, and a meta-analysis was conducted using Review Manager 5.3. Results: Meta-analysis results indicated that the nonpharmaceutical intervention was effective in maintaining the average body temperature from the end of the operation to the time when the patient left the recovery room (standardized mean difference [SMD]: 0.54, 95% CI = [0.33, 0.75], heterogeneity I2 = 51%; p = .05) and during the surgery period (SMD: 0.54, 95% CI = [0.45, 0.65], heterogeneity I2 = 36% ; p = .17). Conclusion: The nonpharmacological intervention of active warming systems exhibited significant alleviating effects on hypothermia both during the operation and from the end of the operation to the time when the patient left the recovery room. Therefore, the study findings should be applied to clinical settings to improve patient care quality.

並列關鍵字

nonpharmacological intervention ； surgery ； hypothermia ； shivering