探討使用保溫措施對剖腹產產婦預防手術全期低體溫之成效

Effectiveness of Warming Interventions in Preventing Perioperative Hypothermia in Women Undergoing Cesarean Section

背景及目的：
剖腹產為產科常見手術，但手術全期低體溫（核心體溫<36℃）及寒顫發生率高達30%至60%，與手術室環境、皮膚暴露及熱量散失相關。低體溫會增加術後不適、延長恢復時間並提高併發症風險。研究指出，主動及被動加溫措施對降低低體溫具有正向效益。本文旨在探討保溫措施對剖腹產產婦手術全期低體溫的潛在成效，以提供臨床護理參考。
方法：
依PICO架構設定關鍵字，搜尋中英文電子資料庫，篩選符合納入條件之研究，並使用JBI評析工具進行品質評估。
結果與討論：
納入三篇隨機對照試驗，共241位剖腹產產婦。結果顯示，主動加溫措施較被動保溫更能有效維持核心體溫、降低寒顫發生率並提升產婦舒適度，其中以輸液加溫（41℃），並於脊髓麻醉後使用對流式保溫毯進行主動加溫（設定43℃）之組合效果最佳。相較之下，單一或局部加溫措施效果有限，術後短時間保溫亦未顯著改善低體溫，顯示低體溫多於術中即開始發生，須及早介入。整體而言，低體溫之發生除與保溫措施相關外，亦受麻醉方式、手術時間及環境溫度等因素影響，建議臨床採取整合性溫度管理策略。惟納入研究樣本數有限且方法不一致，未來仍需更多高品質研究以驗證其長期成效。

Background and Purpose
Cesarean section is a common obstetric procedure; however, the incidence of perioperative hypothermia (core temperature <36℃) and shivering ranges from 30% to 60%, and is associated with operating room environment, skin exposure, and heat loss. Hypothermia may increase postoperative discomfort, prolong recovery time, and raise the risk of complications. Previous studies have indicated that both active and passive warming interventions have beneficial effects in reducing hypothermia. This study aimed to explore the effectiveness of warming interventions in preventing perioperative hypothermia in women undergoing cesarean section, in order to provide references for clinical nursing practice.
Methods:
Keywords were developed based on the PICO framework. Relevant studies were searched in Chinese and English electronic databases. Eligible studies were selected according to the inclusion criteria, and their quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal tool.
Results and Discussion
Three randomized controlled trials involving a total of 241 parturients undergoing cesarean section were included. The results demonstrated that active warming interventions were more effective than passive warming in maintaining core body temperature, reducing the incidence of shivering, and improving maternal comfort. Among these, the combination of warmed intravenous fluids (41℃) and forced-air warming initiated after spinal anesthesia (set at 43℃) showed the greatest effectiveness. In contrast, single or localized warming interventions had limited effects, and short-term postoperative warming did not significantly improve hypothermia. These findings suggest that hypothermia often begins intraoperatively and requires early intervention. Overall, the occurrence of hypothermia is influenced not only by warming strategies but also by factors such as anesthesia type, duration of surgery, and environmental temperature. Therefore, an integrated temperature management approach is recommended in clinical practice. However, due to the limited sample size and methodological heterogeneity among the included studies, further high-quality research is required to evaluate the long-term effectiveness of these interventions.