以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (18): 35-40.doi: 10.16460/j.issn1008-9969.2021.18.035

• 循证护理 • 上一篇    下一篇

复苏室患者术后寒颤评估与干预的最佳证据总结

庄珊珊, 张转运, 王江   

  1. 南京大学医学院附属鼓楼医院 麻醉手术科,江苏 南京 210008
  • 收稿日期:2021-04-16 出版日期:2021-09-25 发布日期:2021-10-12
  • 通讯作者: 张转运（1983-）,女,江苏南京人,本科学历,主管护师,护士长。E-mail：769848417@qq.com
  • 作者简介:庄珊珊（1991-）,女,江苏南京人,本科学历,护师。

Best Evidence Summary for Evaluation and Intervention of Postoperative Shivering in Patients in Post Anesthesia Care Unit

ZUANG Shan-shan, ZHANG Zhuan-yun, WANG Jiang   

  1. Dept. of Anesthesia, Gulou Hospital Affiliated to Medical College of Nanjing University, NangJing 210008, China
  • Received:2021-04-16 Online:2021-09-25 Published:2021-10-12

PDF (PC)

394

赞

摘要： 目的 检索、评价并整合国内外关于复苏室患者术后发生寒颤的评估和干预的最佳证据。方法 检索国际指南网、美国指南网、加拿大安大略注册护士协会、英国医学期刊、Joanna Briggs Library、GeenMedical、Up To Date、苏格兰院际指南网、美国围麻醉期护士协会、Cochrane Library、美国围手术期注册护士协会、Medline、万方、临床诊疗指南、维普、中国知网以及中华医学会麻醉学分会中有关术后寒颤的评估与干预的证据,文献质量评价是在2名以上评价者独自进行证据采集、处理和整合的基础上的完成的。结果 本研究共分析研究了10篇具有代表性的文献,其中指南2篇、专家共识2篇、证据总结1篇、系统评价4篇,随机对照试验1篇,从中总结了包括风险因素、评估时机与评估工具、干预措施和质量控制4个方面的16条最佳证据。结论 医务人员应准确识别寒颤风险因素,并进行及时和标准化的评估,制定相应的干预措施,根据本院实际情况将最佳证据总结应用于临床实践,以提高患者舒适度,降低寒颤及其相关并发症的发生。

关键词: 术后寒颤, 评估, 干预, 复苏室, 循证

Abstract: Objective To retrieve, evaluate and integrate the best evidence of evaluation and intervention of postoperative shivering in patients in post anesthesia care unit. Methods We searched the Guidelines International Network, National Guideline Clearing-house, Registered Nurses'Association of Ontario, British Medical Journal, Joanna Briggs Library, GeenMedical, Up To Date, Scottish Intercollegiate Guidelines Network, American Society of Perianesthesia Nurses, Cochrane Library, The Association of Perioperative Registered Nurses, Medline, Wanfang Data, Clinical Diagnosis and Treatment Guide, VIP, CNKI and Chinese Society of Anesthesiology, to gather evidence for postoperative shivering assessment and intervention. Literature quality assessment was completed on the basis of evidence collection, processing and integration conducted by more than 2 reviewers. Results Ten articles were analyzed, including 2 guidelines, 2 expert consensus, 1 evidence summary, 4 systematic reviews and 1 randomized controlled trial, from which 16 pieces of best evidence were summarized into 4 categories including risk factors, assessment timing and assessment tools, interventions and quality control. Conclusion Accurate identifying, timely and accurate evaluation of the risk factors of shivering, appropriate intervention measures, and application of the best evidence in clinical practice according to the actual situation of the hospital are conducive to improving patient comfort and reducing the occurrence of shivering and its related complications.

Key words: postoperative shivering, evaluation, intervention, post anesthesia care unit, evidence-based

中图分类号: 

  • R472.3
[1] Lopez MB.Postanaesthetic Shivering from Pathophysiology to Prevention[J].Rom J Anaesth Intensive Care,2018,25(1):73-81. DOI:10.21454/rjaic.7518.251.xum.
[2] He L, Xu JM, Liu SM,et al.Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia[J].Biol Pharm Bull,2017,40(2):169-173. DOI: 10.1248/bpb.b16-00651.
[3] Park B, Lee T, Berger K, et al.Efficacy of Nonpharmacological Antishivering Interventions: A Systematic Analysis[J]. Crit Care Med, 2015,43(8):1757-1766. DOI:10.1097/CCM.0000000000001014.
[4] Hong JY, lee IH. Comparison of the Effects of Intrathecal Morphine and Pethidine on Shivering after Caesarean Delivery under Combined-spinal Epidural Anaesthesia[J]. Anaesthesia,2005,60(12):1168-1172.DOI:10.1111/j.1365-2044.2005.04158.x.
[5] 中华医学会神经病学分会神经重症协作组.神经重症低温治疗中国专家共识[J]. 中华神经科杂志,2015,48(6):453-458.
[6] Howes D, Gray SH, Brooks SC, et al .Canadian Guidelines for the Use of Targeted Temperature Management (Therapeutic Hypothermia) after Cardiac Arrest:A Joint Statement from the Canadian Critical Care Society(CCCS),Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG)[J]. Resuscitation,2016, 98:48-63. DOI:10.1016/j.resuscitation.2015.07.052.
[7] 张国栋. 全麻术后寒战的危险因素与防范措施[J].现代养生,2015,12:83.
[8] 刘旭. 小剂量舒芬太尼在剖宫产术腰硬联合麻醉中预防寒颤及牵拉痛的效果评估[J]. 心理月刊,2019,2(4):153-154. DOI:10.19738/j.cnki.psy.2019.02.105.
[9] 王英伟. 剖宫产术腰硬联合麻醉中应用小剂量舒芬太尼预防寒战和牵拉痛的临床效果分析[J].临床研究, 2017,17(23):36-37. DOI:10.3969/j.issn.1671-3141.2017.23.026.
[10] 徐惠,殷小容.全身麻醉术后患者麻醉苏醒期寒颤的观察及护理干预[J].华西医学, 2016, 31(2):361-363.DOI:10.7507/1002-0179.20160097.
[11] Aromataris E,Fernandez R, Godfrey CM, et al.Summarizing Systematic Reviews: Methodological Development, Conduct and Reporting of an Umbrella Review Approach[J]. Int J Evid Based Healthc,2015, 13(3):132-140.DOI:10.1097/XEB.0000000000000055.
[12] Brouwers MC, Kho ME, Browman GP, et al.AGREE II:Advancing Guideline Development,Reporting,and Evaluation in Health Care[J]. Prev Med, 2010, 51(5):421-424. DOI:10.1016/j.jclinepi.2010.07.001.
[13] The Joanna Briggs Institute(JBI). Checklist for Text and Opinion[EB/OL].(2017-07-15)[2019-09-18].http://joannabriggs.org/research/critical-appraisal-tools.html.
[14] The Joanna Briggs Institute(JBI).Critical appraisal tools[EB/OL].(2017-07-15)[2019-09-18].http://joannabriggs.org/research/critical-appraisal-tools.html.
[15] The Joanna Briggs Institute.JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses[EB/OL].[2019-12-10].https://joannabriggs.org/research/criticalappraisal-tools.html.
[16] 胡雁. 循证护理学[M].北京:人民卫生出版社,2018.
[17] The Joanna Briggs Institute(JBI).Joanna Briggs Institute Levels of Evidence and Grades of Recommendation[EB/OL].(2013-10-01)[2019-12-10].https://joannabriggs.org/jbi -approach.html#tabbed-nav=Levels-of-Evidence.
[18] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[19] Madden LK, Hill M, May TL, et al.The Implementation of Targeted Temperature Management: An Evidence-based Guideline from the Neurocritical Care Society[J].Neurocrit Care,2017,27(3):468-487.DOI:10.1007/s12028-017-0469-5.
[20] 朱涛,严敏,李天佐等.麻醉后监测治疗的专家共识(2014)[M].北京:人民卫生出版社,2014:187-192.
[21] Tsukamoto M, Hitosugi T, Esaki K, et al.Risk Factors for Postoperative Shivering after Oral and Maxillofacial Suegery[J].J Oral Maxillofac Surg,2016, 74(12):2359-2362. DOI:10.1016/j.joms.2016.06.180.
[22] Caruselli M.Postoperative Shivering:A Common Phenomenon with Multiple Causes[J]. Minerva Anestesiol,2018,84(12):1340-1342. DOI:10.23736/S0375-9393.18.13138-5.
[23] 刘瑞红,朱松,万晶晶,等.加温输液对预防产妇剖宫产术后低体温和寒颤有效性的Meta分析[J].护理学报,2018,25(2):41-47.DOI:10.16460/j.issn1008-9969.2018.02.041.
[24] Choi KE, Park B, Moheet AM, et al.Systematic Quality Assessment of Published Antishivering Protocols[J]. Anesth Analg,2017, 124(5):1539-1546.DOI:10.1213/ANE.0000000000001571.
[25] 刘守萍,王学军,柴兆.综合护理措施在预防全麻患者苏醒期寒战中的效果评价[J].麻醉安全与质控,2019,3(3):165-167. DOI:10.3969/j.issn.2096-2681.2019.03.010.
[25] 孙艾娣,孙云.手外科护理风险因素识别与护理干预[J].当代护士,2018, 25(1):70-71.
[26] Matsota PK, Koliantzaki IK, Kostopanagiotou GG.Pharmacological Approach for the Prevention of Postoperative Shivering: A Systematic Review of Prospective Randomized Controlled Trials[J]. Asian J Anesthesiol,2019, 57(3):66-84.DOI:10.6859/aja.201909_57(3).0002.
[27] 李青华,朱长聪,陈晨.医疗风险早期识别在医疗安全管理中的应用探索[J].中国当代医药,2020,27(23):176-179.
[28] 中华医学会麻醉学分会.围手术期患者低体温防治专家共识(2017)[J]. 协和医学杂志, 2017, 8(6):352-357.DOI:10.3969/j.issn.1674-9081.2017.06.007.
[29] Olson DM, Grissom JL, Williamson RA,et al.Interrater Reliability of the Bedside Shivering Assessment Scale[J]. Am J Crit Care, 2013,22(1):70-74. DOI:10.4037/ajcc2013907.
[30] 詹青,赵云.目标温度管理实施:基于2017年美国神经重症监护学会目标温度管理指南的解读[J].神经病学与神经康复学杂志,2017, 13(4):157-164. DOI:10.12022/jnnr.2017-0072.
[31] Park B, Lee T, Berger K, et al.Efficacy of Nonpharmacological Antishivering Interventions: A Systematic Analysis[J]. Crit Care Med,2015,43(8):1757-1766. DOI:10.1097/CCM.0000000000001014.
[32] 张凤萍,马冬梅,贺世超.循环水变温毯对食管癌根治术患者术后寒战及炎症应激反应的影响[J].护理实践与研究,2019,16(16):118-119.
[33] 黄朝旭,画妍,李样.宫颈癌根治术全身麻醉苏醒期发生寒战的因素分析[J].检验医学与临床, 2020,17(11):1576-1579.
[34] Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists'Committee on Regional Anesthesia, Executive Committee, and Administrative Council[J].J Pain, 2016,17(2):131-157. DOI:10.1016/j.jpain.2015.12.008.
[35] Apfelbaum JL, Silverstein JH, Chung FF, et al.Practice Guidelines for Postanesthetic Care: An Updated Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care[J]. Anesthesiology,2013,118(2):291-307.DOI:10.1097/ALN.0b013e31827773e9
[36] He L, Xu JM, Liu SM, et al.Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia[J]. Biol Pharm Bull,2017,40(2):169-173. DOI: 10.1248/bpb.b16-00651.
[37] 许敏. 患者围手术期寒颤的护理干预[J].中国现代药物应用, 2015, 9(10):206-207.
[1] 李萍, 靳小雯, 李燕玲, 徐玉兰, 喻姣花, 李卓颖, 李应, 邓睿. 成年患者结直肠镜检查肠道准备不充分的预防及管理证据总结[J]. 护理学报, 2021, 28(9): 22-28.
[2] 龚艳, 蒋琪霞, 陈文芳, 王海宏, 马丽. 手术获得性压力性损伤风险评估量表对手术患者压力性损伤预测效果的研究[J]. 护理学报, 2021, 28(9): 66-70.
[3] 吴晓珩, 杨元立, 胡馨予, 王翠萍, 张萦, 王艳春, 陶艳玲. 住院患者输血全流程管理的循证实践[J]. 护理学报, 2021, 28(8): 33-38.
[4] 肖萍, 宋洁, 吴淑琳, 姜倩倩, 陈海雯, 刘霖. 护生接受痴呆教育干预的研究进展[J]. 护理学报, 2021, 28(7): 26-29.
[5] 高兴莲, 余文静, 肖瑶, 胡娟娟, 赵诗雨, 杨英. 手术患者围术期压力性损伤预防及管理最佳证据总结[J]. 护理学报, 2021, 28(6): 22-26.
[6] 亢东琴, 陆宇晗, 马晓晓, 王云. 国内外癌症患者家属居丧干预研究进展[J]. 护理学报, 2021, 28(5): 12-15.
[7] 周毅峰, 杨继平, 袁浩, 吴娟. 体外循环心脏手术中体温管理证据汇总[J]. 护理学报, 2021, 28(5): 26-31.
[8] 孙丽娜, 丁淑贞, 袁理, 张政, 徐一元. 癌症幸存者复发恐惧干预研究进展[J]. 护理学报, 2021, 28(5): 16-20.
[9] 朱玮玮, 许阳子, 霍婉君, 陈慈玉, 李远添, 凌冬兰. 老年痴呆患者疼痛评估及管理最佳证据总结[J]. 护理学报, 2021, 28(5): 32-37.
[10] 王晓艳, 李牧玲, 谢亭平, 庄卓洵, 何水秀, 郑晓霞, 祝静雯, 陆云涛, 周宏珍. 神经外科患者腰椎穿刺术后最佳卧床时间的循证实践[J]. 护理学报, 2021, 28(4): 31-35.
[11] 夏杰, 段霞, 张佳男, 于婵, 王可可. 高危孕产妇病情预警评估表的构建及信效度检验[J]. 护理学报, 2021, 28(4): 67-72.
[12] 龚德, 王颖敏, 钟丽容, 贾萌萌, 刘婷, 赵娟娟, 李琨. 神经源性膀胱功能障碍评估与管理相关指南的整合研究[J]. 护理学报, 2021, 28(3): 27-33.
[13] 王亚玲, 王冰寒, 张艳, 尹雪, 蒋辛, 熊晓明, 黎华丽. 急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结[J]. 护理学报, 2021, 28(3): 46-52.
[14] 郭汉画, 陈名桂, 孔丽丽, 张晓璇. 重症患者动脉测压导管最佳更换策略的循证实践[J]. 护理学报, 2021, 28(2): 37-41.
[15] 蔡莹莹, 张俊峰, 郑可欣, 张兰芳, 余璐萍, 曾文, 陈梦云, 黄琼珊. 老年肿瘤患者跌倒评估及管理最佳证据总结[J]. 护理学报, 2021, 28(18): 22-27.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 李敏, 孔燕, 崔焱. 库恩范式理论及其对我国护理学科发展的启示[J]. 护理学报, 2021, 28(17): 15 -19 .
[2] 郭雯雯, 汤之明, 苏丽嬛, 孟娜娜, 温丰榕. 跨专业协同宣教活动促进妇婴保健课程改革的研究[J]. 护理学报, 2021, 28(17): 28 -32 .
[3] 吉海燕, 冯莉, 蒋杏茂. 医护交互式小组管理对提升护士评判性思维能力的效果分析[J]. 护理学报, 2021, 28(17): 37 -40 .
[4] 周伟伟. 高频电刀的常见意外伤害原因分析及预防进展[J]. 护理学报, 2012, 19(12): 14 -16 .
[5] 胡娟娟,高兴莲,杨英,马琼. 基于手术室护理信息系统的手术压疮风险评估模块的应用[J]. 护理学报, 2018, 25(18): 27 -29 .
[6] 吴慧芬, 姚亚春, 张静, 黎李. 自制新型眼罩在面部红蓝光治疗患者中的应用[J]. 护理学报, 2021, 28(2): 76 -78 .
[7] 欧阳雅琦, 谢鑑辉, 梅海波, 刘昆, 刘尧喜, 黄源. 364例先天性胫骨假关节患儿照顾者家庭抗逆力现状及影响因素分析[J]. 护理学报, 2021, 28(5): 1 -5 .
[8] 王静, 赵越. 新型冠状病毒肺炎疫情中可封闭式排水呼吸机冷凝水储水罐的研制[J]. 护理学报, 2021, 28(6): 53 .
[9] 迟俊婷, 陈飞, 李思彦, 张静, 陶红霞, 阮海慧, 牛晓丹, 王艳红. 近5年中国科学引文数据库护理干预性系统评价/Meta分析报告质量分析[J]. 护理学报, 2021, 28(17): 1 -5 .
[10] 林嘉琪,吴桂丽. Morse跌倒风险评估量表的临床应用研究进展[J]. 护理学报, 2018, 25(13): 42 -45 .