充氣式保溫毯預(yù)防胃癌根治術(shù)病人圍術(shù)期低體溫的臨床觀察
發(fā)布時(shí)間：2018-07-15 12:04
【摘要】：目的： 體溫是指機(jī)體內(nèi)部的溫度,是人體重要的生命體征之一,人體的溫度是相對(duì)恒定的,恒定的體溫使機(jī)體各器官系統(tǒng)的機(jī)能活動(dòng)持續(xù)穩(wěn)定地保持在較高的水平上,增強(qiáng)了機(jī)體適應(yīng)環(huán)境的能力。機(jī)體在體溫調(diào)節(jié)機(jī)制的調(diào)控下,使產(chǎn)熱過(guò)程和散熱過(guò)程處于平衡,即體熱平衡,維持正常的體溫。如果機(jī)體的產(chǎn)熱量大于散熱量,體溫就會(huì)升高；散熱量大于產(chǎn)熱量則體溫就會(huì)下降,直到產(chǎn)熱量與散熱量重新取得平衡時(shí),才會(huì)使體溫穩(wěn)定在新的水平。然而低體溫卻成為危害病人麻醉手術(shù)安全的重要因素之一。導(dǎo)致病人出現(xiàn)圍術(shù)期低體溫的因素有很多：如病人自身因素,麻醉藥物的影響,環(huán)境因素,手術(shù)種類,輸血、輸液以及大量沖洗液的使用等。圍術(shù)期低體溫會(huì)給病人帶來(lái)許多危害：如麻醉蘇醒時(shí)間增長(zhǎng),術(shù)中出血量增多,手術(shù)部位感染發(fā)生率增加,酸堿平衡失調(diào),呼吸、循環(huán)、神經(jīng)系統(tǒng)并發(fā)癥增多,術(shù)后寒顫、發(fā)熱發(fā)生率增加,甚至危及病人生命。如何加強(qiáng)術(shù)中體溫監(jiān)測(cè),預(yù)防低體溫的發(fā)生,成為臨床麻醉研究的熱點(diǎn)。充氣式保溫毯依靠溫暖氣流在病人肌膚間形成特有的暖流層,使病人始終處于溫暖環(huán)境中,有效地阻止了機(jī)體總熱量的散失。本文擬觀察胃癌根治術(shù)病人圍術(shù)期采用充氣式保溫毯預(yù)防低體溫的臨床效果。 方法： 收集2013年9月至2014年2月期間山東大學(xué)附屬省立醫(yī)院胃腸外科行胃癌根治術(shù)病人100例,ASA Ⅰ～Ⅱ級(jí),男64例,女36例,年齡45-72歲,體重指數(shù)20-25,手術(shù)時(shí)間均在3小時(shí)以上。隨機(jī)分為保溫組和對(duì)照組,每組50例。將室溫調(diào)節(jié)至26°C,所有輸液和沖洗液保持室溫。病人進(jìn)入手術(shù)室后(TO),測(cè)量鼻咽溫,于鼻咽表麻后置入鼻咽溫監(jiān)測(cè)探頭,鼻咽溫探頭自鼻腔插入約10-12cm。并監(jiān)測(cè)心電圖(ECG)、心率(HR)、平均動(dòng)脈壓(MAP)、脈搏氧飽和度(SpO2),建立靜脈通路,靜注鹽酸戊乙奎醚0.01mg·kg-1。保溫組病人入室后用充氣式保溫毯覆蓋下半身,范圍為雙側(cè)髂前上棘連線以下,調(diào)節(jié)充氣溫度為40°C,而對(duì)照組病人常規(guī)處理。 兩組病人采用相同的麻醉方法。靜脈注射咪達(dá)唑侖0.04mg·kg-1,順阿曲庫(kù)銨0.2mg·kg-1,依托咪酯0.2mg·kg-1,舒芬太尼0.5μg·kg-1。面罩通氣3分鐘后氣管插管,行機(jī)械通氣。調(diào)整呼吸機(jī)參數(shù)：呼吸頻率10-12次·mmin-1,潮氣量8-10mg·kg-1,吸呼比1：2,氧流量2.0L·min-1,根據(jù)二氧化碳分壓(維持在35～45mmHg之間)調(diào)節(jié)潮氣量和呼吸頻率。兩組病人術(shù)中均以恒定速度泵入丙泊酚8～12mg·kg-1·h-1,在手術(shù)結(jié)束前10分鐘時(shí),停止丙泊酚的泵入。間斷靜脈注射順阿曲庫(kù)銨0.1mg·kg-1,當(dāng)手術(shù)結(jié)束前半小時(shí)時(shí),停止注射順阿曲庫(kù)銨。手術(shù)過(guò)程中必要時(shí)追加舒芬太尼0.1μg·kg-1。當(dāng)病人出現(xiàn)吞咽或嗆咳后,給予新斯的明lmg。術(shù)中如果需要輸血,將血液置于恒溫箱15分鐘后,再輸入病人體內(nèi)。 記錄采集病人入室后(TO)以及麻醉誘導(dǎo)后30min (T1)、60min (T2)、90min (T3)、120min(T4)、150min(T5)、180min(T6)和手術(shù)結(jié)束(T7)時(shí)的心率(HR)、平均動(dòng)脈壓(MAP)、鼻咽溫度變化。觀察記錄病人術(shù)中出血量。記錄病人蘇醒時(shí)間及有無(wú)寒顫,其中蘇醒時(shí)間為從手術(shù)結(jié)束至病人Steward蘇醒評(píng)分達(dá)到4分所用的時(shí)間。術(shù)后觀察記錄病人有無(wú)發(fā)熱及術(shù)后住院天數(shù),其中發(fā)熱指標(biāo)為體溫在37.4°C以上。所有數(shù)據(jù)均使用SPSS19.0軟件統(tǒng)計(jì)分析,計(jì)量數(shù)據(jù)采用x±s表示,組內(nèi)比較采用重復(fù)測(cè)量數(shù)據(jù)的單因素方差分析,組間比較采用兩樣本t檢驗(yàn),計(jì)數(shù)資料的比較采用x2檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 入室后(TO)測(cè)量鼻咽溫,兩組病人無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。組內(nèi)比較,麻醉誘導(dǎo)后30min (T1)體溫與入室后(TO)體溫相比,兩組病人均明顯降低(p0.05),對(duì)照組病人手術(shù)結(jié)束時(shí)(T7)體溫較入室后(TO)體溫顯著降低(p0.05),保溫組病人體溫雖也呈下降趨勢(shì),但與對(duì)照組相比,下降趨勢(shì)較為緩慢。組間比較,對(duì)照組與保溫組于麻醉誘導(dǎo)后120min (T4)、150min (T5)、180min(T6)及手術(shù)結(jié)束時(shí)(T7),體溫差異顯著(P0.05),保溫組體溫明顯高于對(duì)照組。兩組病人麻醉期間平均動(dòng)脈壓(MAP)、心率(HR)差異無(wú)顯著意義。保溫組病人與對(duì)照組病人相比,術(shù)中出血量及術(shù)后寒顫的發(fā)生率明顯減少(P0.05)。保溫組病人的蘇醒時(shí)間明顯縮短(P0.05),術(shù)后3天內(nèi)發(fā)熱人數(shù)普遍減少,住院天數(shù)也相應(yīng)縮短。 結(jié)論： 胃癌根治術(shù)病人圍術(shù)期采用充氣式保溫毯,可有效預(yù)防低體溫的發(fā)生,縮短麻醉蘇醒時(shí)間,減少術(shù)中出血量,降低術(shù)后寒顫、發(fā)熱發(fā)生率,縮短住院時(shí)間。
[Abstract]:Objective:
Temperature refers to the temperature inside the body. It is one of the vital signs of human life. The temperature of the body is relatively constant. The constant body temperature keeps the function and activity of the organs of the body continuously and steadily at a high level and enhances the ability of the body to adapt to the environment. The body is controlled by the mechanism of temperature regulation to make the heat producing process and The process of heat dissipation is in balance, that is body heat balance, maintaining normal body temperature. If the body's heat production is greater than the heat dissipation, the body temperature will rise, and the temperature will decrease when the amount of heat is greater than the heat production, and the body temperature is stable at a new level until the heat production is rebalanced with heat dissipation. However, low temperature becomes a harm to the patient's anaesthesia. One of the important factors of surgical safety. There are many factors that lead to hypothermia in the perioperative period, such as the patient's own factors, the influence of narcotic drugs, the environmental factors, the type of operation, the blood transfusion, the infusion, and the use of a large number of irrigations. The perioperative hypothermia will bring many hazards to the patients: the increase of the time of the anesthesia recovery and the intraoperative bleeding. The incidence of surgical site infection increased, the incidence of infection was increased, acid-base imbalance, respiratory, circulation, nervous system complications increased, postoperative chills, fever incidence increased, even endanger the patient's life. How to strengthen intraoperative temperature monitoring and prevent hypothermia is becoming a hot spot in clinical anesthesia research. Inflatable insulation blanket relies on warm airflow in disease. The special warm flow layer is formed between the human skin, which makes the patient always in the warm environment and effectively prevents the body's total heat loss. This article is to observe the clinical effect of using inflatable heat insulation blanket to prevent hypothermia during the perioperative period of radical gastrectomy for patients with gastric cancer.
Method:
From September 2013 to February 2014, 100 patients with radical gastrectomy for gastric cancer in the Provincial Hospital Affiliated to Shandong University were collected, including 100 cases of radical gastrectomy for gastric cancer, ASA I to grade II, 64 men, 36 women, 45-72 years of age, 20-25 of body mass index and more than 3 hours of operation. They were randomly divided into heat preservation group and control group, 50 cases in each group. The room temperature was adjusted to 26 degree C, all infusion and flushing. The patient entered the room at room temperature. After the patient entered the operation room (TO), the nasopharyngeal temperature was measured, the nasopharyngeal surface anesthesia was inserted into the nasopharyngeal temperature monitoring probe, the nasopharyngeal temperature probe was inserted about 10-12cm. from the nasal cavity and monitored the electrocardiogram (ECG), heart rate (HR), the mean arterial pressure (MAP), pulse oxygen saturation (SpO2), the venous access and the static injection of the hydrochloric acid quetiquine 0.01mg. Kg-1. thermal insulation group. After the patient was admitted to the hospital, he covered the lower part of the body with inflatable blanket. The area was below the line between the anterior and posterior iliac spine, and the inflation temperature was 40 degrees C.
The two groups of patients were treated with the same method of anesthesia. Intravenous midazolam 0.04mg kg-1, CIS atracurium 0.2mg kg-1, etomidate 0.2mg kg-1, sufentanil 0.5 mu g. Kg-1. mask ventilation 3 minutes after tracheal intubation and mechanical ventilation. Adjust the ventilator parameters: respiratory frequency 10-12 times mmin-1, tidal volume 8-10mg kg-1, absorption ratio 1:2, oxygen Flow 2.0L. Min-1, adjust tidal volume and respiratory frequency according to the partial pressure of carbon dioxide (maintained between 35 to 45mmHg). The two groups of patients were pumped at a constant rate of propofol 8 to 12mg. Kg-1. H-1. At the end of the operation, the pump of propofol was stopped at 10 minutes before the end of the operation. The intravenous injection of atracurium 0.1mg. Kg-1 at the end of the operation was half an hour before the end of the operation. At the time, CIS CIS atracurium was stopped. When necessary, sufentanil was added to the sufentanil 0.1 g. Kg-1. when the patient had swallowing or choking. If a blood transfusion was needed in neostigmine lmg., the blood was placed in the thermostat for 15 minutes and then entered into the patient's body.
Recorded TO and 30min (T1), 60min (T2), 90min (T3), 120min (T4), 150min (T5), 150min (T5), 150min (T5), and the change of nasopharynx temperature. The amount of bleeding during the operation was recorded. The recovery time and shiver were recorded. The awakening time was from the operation. The patient's Steward awakening score was 4 minutes. The postoperative observation recorded the patient's fever and the number of postoperative hospital days, and the fever index was above 37.4 C. All data were analyzed by SPSS19.0 software, and the measurement data were expressed by X + s, and the single factor variance analysis was compared with the repeated measurements. The two sample t test was used in the comparison between the groups. The x2 test was used to compare the count data, and the difference between P0.05 was statistically significant.
Result:
The temperature of nasopharynx was measured in the two groups (P0.05). Compared with the two groups, the temperature of 30min (T1) after induction of anesthesia was significantly lower than that in the two groups (P0.05). The temperature of the control group was significantly lower (P0.05) at the end of the operation (T7) after the operation (T7) and the temperature of TO (TO). The temperature of the patients in the heat preservation group was also decreasing. But compared with the control group, the decline trend was slower. Compared with the control group, the control group and the heat preservation group were 120min (T4), 150min (T5), 180min (T6), and the end of the operation (T7), and the temperature difference was significant (P0.05). The temperature of the heat preservation group was significantly higher than that of the control group. The average arterial pressure (MAP) and heart rate (HR) of the two groups were not significant. Compared with the control group, the amount of intraoperative bleeding and the incidence of postoperative shiver decreased significantly (P0.05). The recovery time of the patients in the heat preservation group was significantly shortened (P0.05), the number of fever in 3 days after the operation was generally reduced and the number of days in hospital was shortened accordingly.
Conclusion:
In the perioperative period of radical gastrectomy, the use of inflatable heat insulation blanket can effectively prevent the occurrence of hypothermia, shorten the awakening time of anesthesia, reduce the amount of bleeding in the operation, reduce the postoperative chills, the incidence of fever, and shorten the time of hospitalization.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.2
本文編號(hào)：2124013
[Abstract]:Objective:
Temperature refers to the temperature inside the body. It is one of the vital signs of human life. The temperature of the body is relatively constant. The constant body temperature keeps the function and activity of the organs of the body continuously and steadily at a high level and enhances the ability of the body to adapt to the environment. The body is controlled by the mechanism of temperature regulation to make the heat producing process and The process of heat dissipation is in balance, that is body heat balance, maintaining normal body temperature. If the body's heat production is greater than the heat dissipation, the body temperature will rise, and the temperature will decrease when the amount of heat is greater than the heat production, and the body temperature is stable at a new level until the heat production is rebalanced with heat dissipation. However, low temperature becomes a harm to the patient's anaesthesia. One of the important factors of surgical safety. There are many factors that lead to hypothermia in the perioperative period, such as the patient's own factors, the influence of narcotic drugs, the environmental factors, the type of operation, the blood transfusion, the infusion, and the use of a large number of irrigations. The perioperative hypothermia will bring many hazards to the patients: the increase of the time of the anesthesia recovery and the intraoperative bleeding. The incidence of surgical site infection increased, the incidence of infection was increased, acid-base imbalance, respiratory, circulation, nervous system complications increased, postoperative chills, fever incidence increased, even endanger the patient's life. How to strengthen intraoperative temperature monitoring and prevent hypothermia is becoming a hot spot in clinical anesthesia research. Inflatable insulation blanket relies on warm airflow in disease. The special warm flow layer is formed between the human skin, which makes the patient always in the warm environment and effectively prevents the body's total heat loss. This article is to observe the clinical effect of using inflatable heat insulation blanket to prevent hypothermia during the perioperative period of radical gastrectomy for patients with gastric cancer.
Method:
From September 2013 to February 2014, 100 patients with radical gastrectomy for gastric cancer in the Provincial Hospital Affiliated to Shandong University were collected, including 100 cases of radical gastrectomy for gastric cancer, ASA I to grade II, 64 men, 36 women, 45-72 years of age, 20-25 of body mass index and more than 3 hours of operation. They were randomly divided into heat preservation group and control group, 50 cases in each group. The room temperature was adjusted to 26 degree C, all infusion and flushing. The patient entered the room at room temperature. After the patient entered the operation room (TO), the nasopharyngeal temperature was measured, the nasopharyngeal surface anesthesia was inserted into the nasopharyngeal temperature monitoring probe, the nasopharyngeal temperature probe was inserted about 10-12cm. from the nasal cavity and monitored the electrocardiogram (ECG), heart rate (HR), the mean arterial pressure (MAP), pulse oxygen saturation (SpO2), the venous access and the static injection of the hydrochloric acid quetiquine 0.01mg. Kg-1. thermal insulation group. After the patient was admitted to the hospital, he covered the lower part of the body with inflatable blanket. The area was below the line between the anterior and posterior iliac spine, and the inflation temperature was 40 degrees C.
The two groups of patients were treated with the same method of anesthesia. Intravenous midazolam 0.04mg kg-1, CIS atracurium 0.2mg kg-1, etomidate 0.2mg kg-1, sufentanil 0.5 mu g. Kg-1. mask ventilation 3 minutes after tracheal intubation and mechanical ventilation. Adjust the ventilator parameters: respiratory frequency 10-12 times mmin-1, tidal volume 8-10mg kg-1, absorption ratio 1:2, oxygen Flow 2.0L. Min-1, adjust tidal volume and respiratory frequency according to the partial pressure of carbon dioxide (maintained between 35 to 45mmHg). The two groups of patients were pumped at a constant rate of propofol 8 to 12mg. Kg-1. H-1. At the end of the operation, the pump of propofol was stopped at 10 minutes before the end of the operation. The intravenous injection of atracurium 0.1mg. Kg-1 at the end of the operation was half an hour before the end of the operation. At the time, CIS CIS atracurium was stopped. When necessary, sufentanil was added to the sufentanil 0.1 g. Kg-1. when the patient had swallowing or choking. If a blood transfusion was needed in neostigmine lmg., the blood was placed in the thermostat for 15 minutes and then entered into the patient's body.
Recorded TO and 30min (T1), 60min (T2), 90min (T3), 120min (T4), 150min (T5), 150min (T5), 150min (T5), and the change of nasopharynx temperature. The amount of bleeding during the operation was recorded. The recovery time and shiver were recorded. The awakening time was from the operation. The patient's Steward awakening score was 4 minutes. The postoperative observation recorded the patient's fever and the number of postoperative hospital days, and the fever index was above 37.4 C. All data were analyzed by SPSS19.0 software, and the measurement data were expressed by X + s, and the single factor variance analysis was compared with the repeated measurements. The two sample t test was used in the comparison between the groups. The x2 test was used to compare the count data, and the difference between P0.05 was statistically significant.
Result:
The temperature of nasopharynx was measured in the two groups (P0.05). Compared with the two groups, the temperature of 30min (T1) after induction of anesthesia was significantly lower than that in the two groups (P0.05). The temperature of the control group was significantly lower (P0.05) at the end of the operation (T7) after the operation (T7) and the temperature of TO (TO). The temperature of the patients in the heat preservation group was also decreasing. But compared with the control group, the decline trend was slower. Compared with the control group, the control group and the heat preservation group were 120min (T4), 150min (T5), 180min (T6), and the end of the operation (T7), and the temperature difference was significant (P0.05). The temperature of the heat preservation group was significantly higher than that of the control group. The average arterial pressure (MAP) and heart rate (HR) of the two groups were not significant. Compared with the control group, the amount of intraoperative bleeding and the incidence of postoperative shiver decreased significantly (P0.05). The recovery time of the patients in the heat preservation group was significantly shortened (P0.05), the number of fever in 3 days after the operation was generally reduced and the number of days in hospital was shortened accordingly.
Conclusion:
In the perioperative period of radical gastrectomy, the use of inflatable heat insulation blanket can effectively prevent the occurrence of hypothermia, shorten the awakening time of anesthesia, reduce the amount of bleeding in the operation, reduce the postoperative chills, the incidence of fever, and shorten the time of hospitalization.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.2
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，本文編號(hào)：2124013
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