术中保温对剖腹肝胆手术患者围术期低体温的影响

目的:探讨术中保温对剖腹肝胆手术患者围术期低体温的影响.方法:将66例行剖腹肝胆手术患者随机分为实验组和对照组各33例,对照组给予常规处理,实验组在对照组基础上给予综合保温处理.观察、记录两组患者入手术室(T1)、麻醉后15 min(T2)、手术开始后30 min(T3)和60 min(T4)、术毕(T5) 鼻咽温(T)、平均动脉压(MAP)、心率(HR)、静脉血氧饱和度(SvO2);记录手术时间(从切皮至缝合完皮肤)、拔管时间(手术结束至拔除气管插管)、术中尿量;记录术后两组患者心率及低氧血症、寒战、躁动发生情况.结果:在T3、T4,实验组HR低于对照组,MAP、T、SvO2高于对照组(P＜0.01);T5实验组T、SvO2与术前比较差异无统计学意义(P＞0.05),而对照组与术前比较差异有统计学意义(P＜0.05).与对照组比较,实验组术中尿量增多,拔管时间缩短,术后心率减慢,低氧血症、寒战、躁动发生率降低(P＜0.05).结论:对剖腹肝胆手术患者围术期实施综合保温处理,可安全、有效地预防术中低体温的发生,降低围术期低氧血症、寒战及躁动的发生率,提高手术成功率.

Effect of keeping warm during operation on perioperative low temperature of patients with hepatobiliary operation under laparotomy

Objective: To explore the effect of keeping warm during operation on perioperative low temperature of patients with hepatobiliary operation under laparotomy.Methods: 66 patients with hepatobiliary operation under laparotomy were randomly divided into an experimental group and a control group(33 cases in each group).The conventional treatment was given to the patients in the control group and the overall warming treatment was provided for the patients in the experimental group.The nasopharyngeal temperature,mean arterial pressure(MAP),heart rate(HR) and venous oxygen saturation(SvO2) were observed and recorded respectively at the time when the patients entered operating room(T1),after anesthesia for 15 minutes(T2),30 minutes(T3) and 60 minutes(T4) after the beginning of operation and after operation(T5);the operation time,extubation time and intraoperative urinary volume were recorded;the heart rate of the patients and the incidence of hypoxemia,chills,agitation were also recorded after operation.Results: The heart rate of the patients was lower and MAP,T,SvO2 was higher in the experimental group(T3,T4) than that of the control group(P<0.01);the differences in the comparison of T and SvO2 were not statistically significant compared with those before operation in the experimental group(T5)(P>0.05) and those differences were statistically significant in the control group(P<0.05);Compared with the control group,urine output increased during operation,extubation time was shortened,the incidence of postoperative low heart rate,hypoxemia,chills and agitation decreased in the experimental group(P<0.05).Conclusion: The implementation of the comprehensive warming treatment in the perioperative period can safely and effectively prevent from intraoperative hypothermia and reduce the incidence of perioperative hypoxemia,chills and agitation so as to increase the success rate of operation.