关键词: 心脏外科手术, 体外循环技术, 低温治疗, 体温管理, 循证实践

Abstract: Objective To To formulate body temperature management plan in cardiopulmonary bypass surgery based on evidence-based practice and to standardize clinical practice and promote continuous quality improvement of body temperature management. Methods With the JBI model of evidence-based healthcare (baseline data review, clinical reform and evidence audit), according to the evidence obtained in the preliminary research, corresponding clinical review indicators and review methods were developed, obstacles were reviewed and analyzed, then the strategies were formulated and the evidence was audited after the application. Results There was no significant difference in the intraoperative nasopharyngeal temperature, oxygenator artery outlet temperature and oxygenator venous inlet temperature before and after the application of the evidence (P>0.05), and the difference in intraoperative bladder temperature was statistically significant (P<0.05). There were statistically significant differences in nasopharyngeal temperature, oxygenator arterial outlet temperature and oxygenator venous inlet temperature at different time points (P<0.05), and the difference in bladder temperature was not statistically significant (P>0.05); at different time points the nasopharyngeal temperature, bladder temperature, oxygenator artery outlet temperature and the oxygenator vein inlet temperature were not statistically significant (P>0.05) before and after the application of the evidence .The incidences of hypothermia, chills, and restlessness after the application of the best evidence were 16.7%, 6.7%, and 13.3% respectively. The difference before the application of the evidence was statistically significant (P<0.001). After the evidence was applied, the intraoperative nasopharyngeal temperature and bladder temperature, oxygenator artery outlet and venous inlet temperature were uniformly lower, and the cooling and rewarming rates were both <0.5℃/min. Before and after the training, the score of intraoperative temperature management related knowledge of the nurses in cardiology specialist team and cardiopulmonary bypass specialists was 76.25±9.62 and 91.25±6.35 respectively, and the difference was statistically significant (P<0.001). Before the application of the best evidence, the operating room nurses' implementation rate of the review indicators 1, 2 and 3 was 63%, 27%, and 100%, respectively. The implementation rate of the remaining review indicators was all below 20%. After the best evidence was applied, the implementation rate of 2, 4-15 had been significantly improved, and the difference was statistically significant (P<0.05). Conclusion Evidence-based temperature management strategies in cardiopulmonary bypass surgery are beneficial for standardizing clinical practice, improving the compliance of nurses in intraoperative temperature management for effective protection of intraoperative myocardium, brain cells and nerve tissue, and reducing related complications to ensure the safety of patients undergoing cardiopulmonary bypass surgery.

Key words: cardiac surgery, extracorporeal circulation, therapeutic hypothermia, temperature management, evidence-based practice