髋关节置换患者术中温热液体补液的护理体会

目的明确术中应用温热液体对择期行髋关节置换术病人术后血压、心率、寒战及肾功能的影响,为临床髋关节置换术中病人应用温热液体补液提供依据。方法选取择期行髋关节置换术病人379例（437髋）,随机分为温热补液组和常温补液组。温热补液组术中静脉输入温度为36.5℃～37.5℃的温热液体（包括库存血）,并采用温度为37.0℃的恒温冲洗液进行术区冲洗;常温补液组术中静脉输入常温22℃～24℃液体及库存血,并用常温冲洗液进行术区冲洗。观察术后血压、心率、寒战及肾功能的变化。结果常温补液组病人术后寒战及寒冷不适感发生率明显高于温热补液组（P〈0.05）,寒战程度及寒冷不适度较温热补液组严重（P〈0.05）;温热补液组患者术中心率、平均动脉压均低于常温补液组但差距无统计学意义（P〉0.05）。两组间尿量差距无统计学意义（P〉0.05）。结论髋关节置换术病人术中给予温热液体有利于降低术后寒战发生率,减轻寒战严重程度及寒冷不适度,有利于提高患者的手术耐受。

Nursing Experience of Warm Fluids Application during the Operation of Total Hip Replacement

Objective To find out whether intraoperative pre-warmed solutions（IPWS） administration has any effect on postoperative changes of blood pressure,heart rate,shivering and renal function in selective hip replacement surgery patients.Methods The selective hip replacement patients of 379 cases（437 hips） were divided into IPWS group and the normal temperature（NS） group.In IPWS group,36.5 ℃ ～ 37.5 ℃ pre-warmed fluids had been used for intravenous infusion and 37.0 ℃ thermostat fluids was used for surgical field rinsing.In NS group,all fluids were kept at room temperature 22 ℃ ～ 24 ℃.Blood pressure,heart rate,shivering and renal function changes were monitored.Results The incidence of postoperative shivering and other cold discomfort was significantly higher in NS group（P 0.05） and the severity of shivering and other cold discomfort was also significantly higher in NS group（P 0.05）.Intraoperative heart rate and the average of blood pressure were lower in IPWS group but there was no statistically significant difference（P 0.05）.Urine output difference between the two groups was not significant（P 0.05）.Conclusion The administration of IPWS can help hip replacement surgery patients to reduce the incidence of postoperative shivering and other cold discomfort as well as the severity of them.IPWS can improve patients＇ tolerance to the surgery as well.