岡田 忍

AIM: We tested a hypothesis that postoperative active warming and/or arm leg stretches reduce the difference between core and skin temperatures (primary variable) improving the peripheral circulation immediately after major abdominal surgery. METHODS: Fifty-one patients undergoing major abdominal surgeries were randomly assigned to receive one of three interventions immediately after surgery; routine care (control group), mild intermittent exercise on the bed (exercise group), and forced-air warming (warming group). Core and skin temperatures and perfusion index were continuously measured from anesthesia induction to 12 h after arrival at the ward. RESULTS: Core body temperature was maintained over 37°C with a relatively greater gap between core and skin temperatures over 1°C and reduced perfusion index in the early postoperative period in the control group. In the warming group, the reduced skin temperature at arrival at the ward approximated to the core temperature leading to significant reduction of the temperature gap and increasing the perfusion index to the preoperative level. Although less evident, both the temperature gap and peripheral perfusion significantly improved in the exercise group after 6 and 8 h after arrival at the ward, respectively. CONCLUSIONS: Vasoconstriction in response to cessation after anesthesia and surgery serves to maintain core temperature, but impairs peripheral circulation. Active warming and intermittent mild exercise immediately after arrival at the ward reduces the temperature gap and improves peripheral circulation during the early postoperative period. While cost-effectiveness needs to be considered before clinical application of the intervention, the cost-free mild exercise may be a feasible option for improving postoperative patient care.

背景：手術機器の細菌汚染は，手術部位感染のリスクを増大させることが示唆されている．さらに，手術全体を通して使用する機会が多い電気メスは，細菌を媒介する可能性が他の手術機器に比べて高いといえる． 方法：腸管処置を伴う消化器手術を対象に，手術に使用された電気メスより試料採取を行い，生化学的方法ならびに質量分析法にて菌種の同定を行った．対象手術は，結腸手術（COLO）と直腸手術（REC），胆道再建を伴う肝切除術（BILI-O）と膵頭十二指腸切除術（BILI-PD）とした． 結果：31例中30例にて細菌が検出され，147種類のコロニーを分離し，皮膚に由来するCNS 45（30.6%），S.aureus 6（4.1%），腸管に由来するEnterococcus spp. 20（13.6%），E. coli 5（3.4%）などの細菌を同定した．31例中4例で切開創SSIが発生し，電気メスから検出された細菌と切開創SSIの起因菌が一致していた症例は4例中3例であり，主な起因菌はE. faecalis，E. coliなどであった． 考察：電気メスは，皮膚のみならず腸管が由来であると推測される細菌によっても汚染されており，検出された細菌が切開創SSIの起因菌と一致している症例もみられた．本研究により，電気メスが細菌を媒介し，直接的または間接的に術野の汚染を引き起こす可能性が示唆された．