目的 探讨静脉输注18-氨基酸治疗术后低体温寒战的最佳剂量.方法 选择麻醉恢复室中发生寒战2级或2级以上持续3 min且鼓膜温度＜36℃、在硬膜外复合全麻下行胃肠道肿瘤手术的患者80例,ASA Ⅰ～Ⅱ级,年龄18～65岁,随机分为4组(n=20):D2～8组分别以2、4、6、8 mL· kg-1·h-1的速率输注18-氨基酸注射液,记录寒战发生时及输注氨基酸后每5 min间隔的寒战等级、鼓膜温度和热舒适度评分;记录寒战持续时间和鼓膜温度升高值;记录氨基酸输注开始时和输注60 min后的血糖和血乳酸浓度以及输注过程中恶心、呕吐和再次寒战的发生情况.结果 D2～8组寒战(3/2级)人数分别为14/6、15/5、16/4和15/5,D2～8组输注氨基酸60 min后,鼓膜温度分别升高1.51、1.57、1.91和2.13℃,热舒适度评分分别达50.8、53.3、58.4和61.5,4组间比较差异有统计学意义(P＜0.05).D2～8组寒战持续时间分别为28、27、24.5和23 min,与D2组相比,D8组寒战持续时间显著缩短(P＜0.05),其余各组比较差异无统计学意义.与0 min相比,D2～8组在10 min后寒战等级降低,鼓膜温度显著升高(P＜0.05),热舒适度评分显著升高(P＜0.05);25 min后寒战人数显著减少(P＜0.05);60 min血糖浓度显著升高(P＜0.05).D6和D8组输注60 min后血乳酸浓度显著降低(P＜0.05).4组间恶心、呕吐和再次寒战的发生率无差异.结论 静脉输注18-氨基酸2～8 mL· kg-1·h-1能剂量依赖性改善低体温,提高热舒适度,但治疗3级寒战患者的效果并不理想.

Background: Postoperative shivering is a frequent complication of surgery in developing countries and there is no satisfying method to treat it, let alone to cure it. We studied whether intravenous amino acid (AA) infusion can cure postoperative shivering in the postanesthesia care unit.Methods: Sixty postanesthesia care unit patients with shivering grade 2 or higher and tympanic temperature <36 degrees C received randomly either infusion of Novamin 18 AAs (2 mL/kg/h), pethidine (0.5 mg/kg), or tramadol (1 mg/kg). Tympanic temperature, shivering grade, and thermal comfort were assessed every 5 min for 60 min. Blood glucose and lactic acid concentrations were measured before and after treatment. Postoperative nausea and vomiting were also recorded.Results: Shivering stopped within 5 min in the pethidine and tramadol groups versus 90% stopped within 15 min in AA group. There were five cases of reshivering in the tramadol group versus none in the AA or pethidine groups. Tympanic temperature increased slowly in all patients but increased significantly faster in the AA group. Thermal comfort improved significantly faster in the AA group versus the other two groups, thermal comfort was significantly higher in the tramadol versus the pethidine group >= 35 min. Blood glucose concentration in AA group increased to 135.18 +/- 9.18 mg/dL. There were some cases of nausea and vomiting in pethidine and tramadol groups but none in the AA group.Conclusion: Novamin infusion can stop postoperative shivering and alleviates hypothermia and improves thermal comfort more effectively than tramadol and pethidine with less nausea and vomiting and causes a clinically acceptable blood glucose increase with no reshivering episodes. (C) 2014 Elsevier Inc. All rights reserved.