1.上海交通大学;2.日本千叶大学;3.日本千叶大学 / 上海交通大学千叶大学国际合作研究中心
1.Shanghai Jiao Tong University;2.Chiba University;3.Chiba University / Shanghai Jiao Tong University Chiba University ICRC
目的: 通过构建计算机仿真模型分析全身麻醉引起的体温调节系统的损伤和手术室低温环境对个体化病人围手术期体温调节的影响。方法 本文开发了一个麻醉模型，通过降低基本代谢率、皮下血管收缩和骨骼肌颤抖的阈值来模拟麻醉效果，并耦合到作者建立的“皮肤-体核”二节点体温调节模型中。该模型可通过设置骨骼肌颤抖产热、出汗、及皮下血管舒缩能力的强弱模拟年龄衰老导致的热调节能力损伤、设置不同脂肪厚度模拟肥胖、设置心血管模型参数模拟不同的心血管疾病，进而计算分析这些个体化特征对低温麻醉条件下体温调节的影响。 结果: 计算结果显示在低温环境下，与年轻人相比，老年人体核温度较低，体表温度较高。脂肪厚度的增加或左心室功能衰竭的加重，都有可能缓解低温环境中体核温度的下降。风速或相对湿度的增加会导致体核温度的降低。最引人注目的是，当麻醉引起的血管收缩的阈值降低约0.5-3℃时，会引起体核温度的显著降低。 结论: 通过模型预测与实验测量的结果对比，本文验证了该模型的可靠性。身体的个体化特征对低温环境下人体温度调节有重要影响。个体体征与全身麻醉的结合进一步复杂化了人体的体温调节，给临床医师带来巨大的挑战。
Objective: A computer simulation model was constructed to analyze the effects of anesthesia-induced thermoregulatory system impairment and low-temperature environment of the operating room on the perioperative thermoregulation of individualized patients. Method This study proposes a simple anesthesia model and incorporates it into our developed individualized thermoregulatory model，which can be used to assess the effects of individualized characteristics such as age, obesity, and cardiovascular disease on thermoregulation by modifying different model parameters. Modeling the effects of general anesthesia on human thermoregulation can be achieved by reducing basal metabolic rate and the thresholds for vasoconstriction and shivering. Results: The model simulation results show that the elderly show lower core temperature but higher skin temperature, compared with the young people. In a low-temperature environment, an increase in fat thickness or an increase in the severity degree of the left ventricular failure may alleviate the decrease of core temperature, while an increase in wind speed or relative humidity can result in a decrease of core temperature. Most strikingly, when the threshold setting of vasoconstriction is reduced by about 0.5-3 ° C, the core temperature decreases down to as low as 33° C. Conclusions: By comparing model simulations with experimental measurements, the reliability and validity of the model in predicting human transient thermal responses during varying external thermal environment was verified. With this model, we found the individualized characteristics of the human body have an important influence on human body temperature in a low-temperature environment. Moreover, the combination of individualized characteristics of the human body and general anesthesia further complicates the body's thermoregulation and poses significant challenges for clinicians.