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| 体温保护对剖腹胃癌根治术患者快速康复的影响 |
| Effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy |
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| DOI：10.12089/jca.2018.01.007 |
| 中文关键词: 体温保护 胃癌根治术 围术期低体温 快速康复 |
| 英文关键词: Temperature protection Laparotomy radical gastrectomy Inadvertent perioperative hypothermia Enhanced recovery after surgery |
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| 中文摘要: |
| 目的 观察体温保护对剖腹胃癌根治术患者快速康复的影响。方法 选择剖腹胃癌根治术患者60例,男39例,女21例,年龄45～76岁,ASA Ⅰ或Ⅱ级,随机分成升温组和对照组,每组30例。升温组患者入室后给予体温保护,开启升温毯至42℃直至患者离开PACU,暴露皮肤均予以干净敷料覆盖,输注液体(包括复方乳酸钠、羟乙基淀粉及红细胞悬液)和腹腔冲洗液体均加热至40℃,呼吸过滤器安置于气管导管处。对照组患者未给予特殊保温加热措施。手术室温度调节至21～23℃。采用红外线鼓膜耳温计观察并记录两组患者入室时(T1)、麻醉诱导前(T2)、术中(T3)、关腹(T4)、拔管(T5)、离开PACU(T6)时患者的核心温度。观察并记录患者麻醉时间、手术时间、手术室温度、术中出血量、术中输血量、麻醉药物用量、总输液量和腹腔液体冲洗量、拔管时间和住院时间等;记录术后寒战、切口感染的发生情况。结果 与T1时比较,T2～T6时两组核心温度均明显降低,且升温组核心温度明显高于对照组(P<0.05)。升温组术中出血量、术中输血量明显少于,拔管时间和住院时间明显短于,术后寒战及切口感染的发生率明显低于对照组(P<0.05);两组麻醉时间、手术时间、手术室温度、麻醉药物用量、总输液量、腹腔冲洗液量差异无统计学意义。结论 多方法 联合体温保护措施,能明显降低剖腹胃癌根治术患者围术期低体温的发生,有利于患者术后康复。 |
| 英文摘要: |
| Objective To observe the effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy. Methods Sixty of patients ASA physical status Ⅰ or Ⅱ, aged 45-76 years, scheduled for elective radical gastrectomy were randomly divided into 2 groups (n=30 each): heating blanket group and control group. In the heating blanket group, patients were warmed up during the whole perioperative period using the warmblanket until discharge from PACU; exposed skin as covered with clean surgical dressing; infusion, irrigation fluids and blood transfusions were warmed to 40℃; the bacteriological and viral filters were placed between the Y-piece of the breathing circuit and the tracheal tube. In the control group, patients were not given special heat preservation measures. For temperature measurements, an infrared tympanic ear thermometer was used. The core temperature of two groups were recorded at the pre-operative period (T1), before induction (T2), 1 h after induction (T3), closing (T4), extubation (T5), discharging from PACU (T6). The dosage of anesthetic drug, volume of fluids infused, peritoneal fluid flushing volume, operation time, anesthesia time, ambient temperature, amount of bleeding, intraoperative blood transfusion, shivering, extubation time, incision infection and hospitalization time were recorded. Results There was no statistical difference in terms of temperature at T1 between the two groups. Compared with the T1, the core temperature of two groups of patients in T2-T6 were significantly decreased (P<0.05). The perioperative core body temperature at T2-T6 was significantly higher in the heating blanket group than in the control group. The amount of bleeding and blood transfusion in perioperative period was significantly less that in the heating blanket group (P<0.05). The incidence of shivering and surgical-wound infection were significantly lower in the heating blanket group (P<0.05). The extubation time and hospitalization time were shorter in the heating blanket group (P<0.05). Conclusion Combined body temperature protection measures can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and improve postoperative outcomes for patients undergoing laparotomy radical gastrectomy. |
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