【摘要】：目的觀察曲馬多靜注聯(lián)合物理保溫預(yù)防老年患者經(jīng)尿道前列腺電切術(shù)(trans urethral resection prostate,TURP)圍術(shù)期低體溫發(fā)生的臨床意義。方法收集本科2014年6月至2015年6月擬行TURP的老年患者75例,年齡60~70(64.58±2.24)歲。采用抽簽的方法分為曲馬多藥物保護(hù)組、物理保溫組和聯(lián)合保護(hù)組,每組25例。入室心電監(jiān)護(hù),觀察并記錄肛溫,3組患者均采用腰麻聯(lián)合硬膜外麻醉。曲馬多藥物保護(hù)組患者給予常規(guī)干預(yù),麻醉后靜脈給予曲馬多1.5 mg/kg稀釋后緩慢靜注,等滲沖洗液及靜脈輸液均為室溫(22℃),圍術(shù)期不作任何加溫保護(hù)。物理保溫組等滲沖洗液及靜脈輸注液體預(yù)先加溫至38℃,手術(shù)床鋪設(shè)38℃循環(huán)水毯,充氣加溫毯進(jìn)行體表覆蓋。聯(lián)合保護(hù)組患者綜合上述兩種保護(hù)方法。記錄3組患者術(shù)前(T1)、手術(shù)開始即刻(T2)、手術(shù)1 h(T3)、手術(shù)結(jié)束(T4)體溫。同時評估患者術(shù)后寒戰(zhàn)、心律失常發(fā)生情況和術(shù)后平均住院時間。結(jié)果 3組患者術(shù)前一般情況及術(shù)中輸液量和沖洗液量比較差異無統(tǒng)計學(xué)意義(P0.05)。T3、T4時刻,聯(lián)合保護(hù)組體溫明顯高于其余兩組(P0.05)。單純物理或者藥物保護(hù)組患者隨手術(shù)時間推移,體溫呈逐漸下降趨勢,T3、T4時刻與術(shù)前體溫比較有明顯差異(P0.05),而聯(lián)合保護(hù)組患者圍術(shù)期體溫沒有明顯的波動。聯(lián)合保護(hù)組圍手術(shù)期的寒戰(zhàn)、心律失常發(fā)生率低于其他兩組,術(shù)后平均住院天數(shù)也明顯低于其他兩組(P0.05)。結(jié)論曲馬多靜注聯(lián)合物理保溫能更有效地避免老年患者TURP術(shù)中低體溫的發(fā)生,并減少寒戰(zhàn)、心律失常和尿路感染等并發(fā)癥發(fā)生。
[Abstract]:Objective to observe the clinical significance of tramadol intravenous injection combined with physical insulation in the prevention of perioperative hypothermia in elderly patients undergoing transurethral resection of prostate (trans urethral resection prostate,TURP). Methods from June 2014 to June 2015, 75 elderly patients aged 60-70 (64.58 鹵2.24) with TURP were collected. The patients were divided into tramadol drug protection group, physical insulation group and combined protection group with 25 cases in each group by drawing lots. The anal temperature was observed and recorded. All the patients in the three groups were treated with spinal anesthesia combined with epidural anesthesia. The patients in tramadol protection group were treated with conventional intervention. After anesthesia, tramadol was diluted by intravenous injection for 1.5 mg/kg and intravenous infusion was given at room temperature (22 鈩，

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