加温输液对乳癌根治术病人出凝血机制的影响

目的 减少病人术中出血。方法 将80例乳癌根治术病人随机分成观察组（加温输液）和对照组（室温输液）各40例。观察组在手术过程中输入加温液体（37－38℃），腹部以下盖保温毯，使肛温保持在36－37℃；对照组输入室温液体（20－21℃），不用保温毯。比较两组术后体温、出血量、输血量及部分凝血项目测定值。结果 观察组与对照组手术终止和手术后2h体温比较，均P＜0.05，差异有显著性意义；术中出血量、输血量比较，均P＜0.01，差异有极显著性意义。术后血小板（PLT）计数、凝血酶原活动度（PT％）及纤维蛋白原含量（FIB）比较，均P＜0.05，差异有显著性意义。结论 加温输液可使病人术中术后的体温维持正常，出血量减少。     

不同保温方法对胃癌根治术患者外周血白细胞介素的影响

目的观察不同保温方法对胃癌手术患者外周血白细胞介素IL-2、IL-6、IL-10的影响,为选取适宜保温方法提供参考。方法将75例胃癌根治术患者随机分为常规保温组(A组)、身体包裹组(B组)、保温毯组(C组)、输液输血加温+身体包裹组(D组)及输液输血加温+保温毯组(E组)五组,在术前(T0)、术后24h(T1)、术后48h(T2)采外周血,检测血浆中IL-2、IL-6、IL-10浓度。结果各组IL-2、IL-6、IL-10血浆浓度在T0、T1、T2呈规律性变化。其中,E组T1时IL-2血浆浓度显著高于其他组,IL-10显著低于其他各组(均P0.05)。结论不同保温方法对胃癌患者术后IL-2、IL-10浓度有影响,手术过程中采用输液输血加温+保温毯的保温方法有利于维持患者免疫功能。     

老年患者全膝关节置换围术期不同输血输液温度对术后恢复质量的影响

目的评价老年患者全膝关节置换(total knee arthroplasty,TKA)围术期接受不同温度的输血输液对患者术后恢复质量的影响。方法选择择期行单侧TKA的患者156例,男42例,女114例,年龄65~85岁,ASAⅠ或Ⅱ级,随机分为三组:常温组(NT组)、恒温组(CT组)和加温组(WT组),每组52例。NT组采用室温(22~24℃)下输血输液及室温冲洗液对术区进行冲洗;CT组采用加温装置使输血输液温度升高至37℃,并使用37℃冲洗液行术区冲洗;WT组使输血输液温度升高至37℃,并使用39℃冲洗液行术区冲洗。观察患者术前(T0),手术开始30min(T1)、手术开始1h(T2),术毕30min(T3)及术毕1h(T4)的鼻咽温度,记录患者自主呼吸恢复时间、呼之睁眼时间、意识清醒时间、拔管时间及Steward评分。采用PQRS量表评估患者拔管后15、40min及术毕1、3、30d的认知功能恢复情况。结果与T0时比较,T1~T4时三组患者的鼻咽温度均明显降低(P0.05或P0.01);T1~T4时CT组和WT组的鼻咽温度明显高于NT组(P0.01);T4时WT组的鼻咽温度明显高于CT组(P0.05)。WT组意识完全清醒时间明显短于NT组(P0.01),Steward评分明显高于NT组(P0.05)。CT组和WT组的呼之睁眼时间、自主呼吸恢复时间明显短于NT组(P0.01)。与拔管前比较,三组患者在拔管后15、40min及术后1、3、30d的认知功能恢复质量评分均明显升高(P0.01),CT组和WT组在拔管后15、40min及术后1、3、30d的认知功能恢复质量评分明显高于NT组(P0.05),WT组术后30d的认知功能恢复质量评分明显高于CT组(P0.05)。结论 TKA围术期老年患者输注37℃血液及液体并在术区使用39℃冲洗液,可有效防止低体温发生,改善苏醒质量及术后认知功能。     

充气式保温毯联合输液加温对全麻食管癌手术苏醒和免疫功能的影响

目的探讨充气式保温毯联合输液加温技术对食管癌手术苏醒和免疫功能的影响。方法择期行食管癌根治术患者50例,随机分为温毯+输液输血加温组(W组)和对照组(C组),每组25例。记录麻醉诱导前(T1)、手术开始2h(T2)、手术结束时(T3)、术后2h(T4)的鼻咽温,及麻醉苏醒时间、术后寒战、术后感染及住院时间;采用流式细胞仪检测T1、T3、术后2d(T5)及5d(T6)外周血T淋巴细胞亚群。结果 C组在T2~T4时的鼻咽温较T1时明显降低(P0.05);W组在T2~T4时的鼻咽温明显高于C组(P0.05);C组患者苏醒时间明显延长、术后寒战发生率明显高于W组(P0.05);与T1时比较,两组T3时CD4+淋巴细胞百分率及CD4+/CD8+均明显下降,CD8+淋巴细胞百分率明显升高(P0.05);在T3时,W组CD4+淋巴细胞百分率及CD4+/CD8+明显高于C组,CD8+淋巴细胞百分率明显低于C组(P0.05)。结论在食管癌根治手术中,采用充气式保温毯联合输液加温技术具有保护患者体温、缩短患者苏醒时间、减少术后寒战的发生,同时有利于保护患者的免疫功能。     

体温保护在老年患者人工全膝关节置换术后快速康复中的应用效果

背景:老年患者人工全膝关节置换术常并发术中低体温,后者是影响患者快速康复的重要因素。目的:评价体温保护在老年患者人工全膝关节置换术后快速康复应用中的效果。方法:选取全身麻醉下行人工全膝关节置换术患者40例,性别不限,年龄大于60岁,BMI 18.0~24.0 kg/m^2,ASA分级Ⅱ级或Ⅲ级,MMSE评分>24分,采用随机数字表法分为两组:常规保温组(n=20)和体温保护组(n=20)。常规保温组采用普通套被行覆盖式保温,体温保护组采用升温毯处理,温度调至37℃~41℃,术中监测患者鼻咽温。两组患者输血输液均经过温箱升温至37℃,术中采用温水冲洗。维持室温22℃~24℃,相对湿度50%。于入室时(T0)、手术1 h(T1)和术毕时(T2)记录两组患者鼻咽温。记录两组患者手术时间、出血量、苏醒时间,苏醒延迟、术后躁动、寒颤、术后恶心呕吐(PONV)及术后谵妄(POD)的发生情况。结果:与T0时比较,常规保温组T1和T2时鼻咽温降低(P<0.01)。与常规保温组比较,体温保护组T1和T2时鼻咽温升高(P<0.05);烦躁、苏醒延迟、PONV和POD的发生例数降低(P<0.05);出血量、PACU停留时间及住院日减少(P<0.05)。结论:体温保护可降低老年患者人工全膝关节置换术后并发症,促进快速康复。     

体温保护在老年患者人工全膝关节置换术后快速康复中的应用效果

背景:老年患者人工全膝关节置换术常并发术中低体温,后者是影响患者快速康复的重要因素。目的:评价体温保护在老年患者人工全膝关节置换术后快速康复应用中的效果。方法:选取全身麻醉下行人工全膝关节置换术患者40例,性别不限,年龄大于60岁,BMI 18.0~24.0 kg/m^2,ASA分级Ⅱ级或Ⅲ级,MMSE评分>24分,采用随机数字表法分为两组:常规保温组(n=20)和体温保护组(n=20)。常规保温组采用普通套被行覆盖式保温,体温保护组采用升温毯处理,温度调至37℃~41℃,术中监测患者鼻咽温。两组患者输血输液均经过温箱升温至37℃,术中采用温水冲洗。维持室温22℃~24℃,相对湿度50%。于入室时(T0)、手术1 h(T1)和术毕时(T2)记录两组患者鼻咽温。记录两组患者手术时间、出血量、苏醒时间,苏醒延迟、术后躁动、寒颤、术后恶心呕吐(PONV)及术后谵妄(POD)的发生情况。结果:与T0时比较,常规保温组T1和T2时鼻咽温降低(P<0.01)。与常规保温组比较,体温保护组T1和T2时鼻咽温升高(P<0.05);烦躁、苏醒延迟、PONV和POD的发生例数降低(P<0.05);出血量、PACU停留时间及住院日减少(P<0.05)。结论:体温保护可降低老年患者人工全膝关节置换术后并发症,促进快速康复。     

不同保温方法对脊柱手术患者围术期核心体温和恢复情况的影响

目的比较不同保温方法对脊柱手术患者围手术期核心体温及术后恢复的影响。方法选择行择期全麻脊柱手术患者80例,男45例,女35例,年龄18～80岁,BMI 18～25 kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法分为四组,静脉输液加温组(FW组);强力空气加温毯加温组(AW组);静脉输液加温+强力空气加温毯组(FA组);入手术室前强力空气加温毯预热30 min,术中静脉输液加温+强力空气加温毯组(PFA组),每组20例。入室前FW组、AW组和FA组不予处理,PFA组于术前等候室采用强力空气加温毯预热30 min。术中FW组输入经血液/液体升温仪加热至41℃的液体直到手术结束。AW组将强力空气加温毯覆盖于患者的下肢部位上方,设定温度为43℃。FA组和PFA组均采用输液加温和强力空气加温毯加温。记录患者在麻醉诱导后、切皮后30 min、切皮后60 min、入PACU 10 min和术后48 h时的核心体温;记录患者术后寒战、恶心呕吐发生情况,患者满意度评分和住院时间。结果切皮后30 min FW组核心体温明显低于PFA组(P0.01);切皮后60 min和入PACU 10 min时FW组核心体温明显低于AW组、FA组和PFA组(P0.001)。FW组术后寒战发生率明显高于AW组、FA组和PFA组(P0.05)。四组患者术后恶心呕吐发生率差异无统计学意义。FW组术后患者满意度评分明显低于AW组、FA组和PFA组(P0.05)。四组患者术后住院时间差异无统计学意义。结论脊柱手术全麻患者围手术期强力空气加温毯保温效果优于输液加温,提高了患者满意度,而强力空气加温毯联合输液加温及预热并没有明显优于单纯使用强力空气加温毯保温。静脉输液加温、强力空气加温毯加温及预热保温方法对患者术后恢复的影响无差异。     

保温温度对老年肝癌患者体温及麻醉恢复的影响

目的 探讨利用充气保温毯设置不同保温温度和时间对老年肝癌患者术中体温及麻醉恢复情况的影响。方法 选取宁波市医疗中心李惠利医院2018 年2 月至2018 年11 月拟于全麻腹腔镜下行肝癌切除术的老年患者120 例进行前瞻性分析。将患者随机分为4 组，每组30 例，患者自入室至术毕全程使用充气保温毯保温，每组具体实施：中档组（M组），自患者平卧至出手术室持续给予38 ℃热空气吹入保温毯中；综合组1（Z1 组），患者平卧后先调整加热充气温度为43 ℃热空气吹入保温毯，1 h后调节为38 ℃的热空气吹入，直至手术结束；综合组2（Z2组），患者平卧后先调整加热充气温度为43 ℃热空气吹入保温毯，2 h后调节为38 ℃的热空气吹入，直至手术结束；高档组（H组），自患者平卧至离开手术室调整加热充气温度为43 ℃热空气持续吹入保温毯。分别于麻醉诱导后即刻（T1）、手术开始后30 min（T2）、手术开始后1 h（T3）、手术开始后2 h（T4）及手术结束时（T5）5个时间点记录四组患者鼻咽温，术后记录患者苏醒时间，寒战、躁动、发热等麻醉恢复情况，比较4 组患者术中的保温效果及对麻醉恢复的影响。结果 所有患者自入室至术毕测得鼻咽温均随时间呈逐步下降趋势，比较有统计学差异（F=62.690，P＜0.01）；T3、T4 时点M组鼻咽温低于Z1、Z2和H组；T5时点Z1组鼻咽温高于H组，比较均有统计学差异（P＜0.05）。Z1和Z2组患者苏醒时间明显短于M和H组；Z1组患者躁动发生率小于M、Z2和H组；Z1和M组患者的发热发生率低于H组和Z2组，比较均有统计学差异（P＜0.05）。结论 充气加温毯设置为43 ℃ 1 h后调节为38 ℃的保温策略更有利于维持老年肝癌患者腹腔镜手术的术中体温，对术后麻醉恢复具有积极意义。     

术中保温对胰十二指肠切除患者体温及凝血功能的影响

目的 观察术中采取保温措施对胰十二指肠切除患者体温及凝血功能的影响.方法 将60例择期行胰十二指肠切除术患者随机分为对照组和观察组各30例.对照组按常规进行手术;观察组在常规手术的基础上,采取电子加温毯、充气温控毯加强躯体保温,采用输液加温器对输入液体进行加温.两组分别于患者麻醉前、手术开始后30、90、180、270 min及术毕测量患者肛温及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT).结果 随着手术的进行,不同时间的体温及各项凝血指标比较,差异有显著性意义(均P＜0.01);对照组手术开始后及结束时体温下降,PT、APTT、TT延长,观察组波动较小,两组比较,差异有显著性意义(均P＜0.01).结论 胰十二指肠切除患者术中采取电子加温毯、充气温控毯和输液加温器等保温措施可维持患者的体温及凝血功能.     

术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响

［摘要］ 目的 探讨术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响。方法 选取择期行机器人腹腔镜膀胱癌根治术患者60例,年龄18～65岁,ASAⅠ~Ⅲ级,随机分为对照组和加温输液组,每组30例。对照组采用常规保温措施（室温24℃以上、患者身体覆盖棉被、预热腹腔冲洗液、术后采用充气式升温系统复温）;加温输液组在常规保温措施的基础上术中持续加温输液,温度设置为41℃。观察患者围术期核心体温（鼻咽温）和PT、APTT、TT、Fib、PLT等凝血指标的变化。结果 对照组术中体温进行性下降（最低35℃）,除了基础值和术后1 h以外的各时间点体温均低于加温输液组,差异有统计学意义（P<0.05）;加温输液组术中体温与基础值比较也有下降（P<0.05）,但均在36℃以上。对照组APTT的延长时间大于加温输液组（P<0.05）、TT的缩短时间大于加温输液组（P<0.05）;PT、Fib、PLT组间比较无统计学差异。结论 机器人腹腔镜膀胱癌根治术中采用持续加温输液,可维持患者体温正常,避免低体温引起的凝血功能紊乱。     

Peroperative Hypothermia

Heat loss during anesthesia and operation and subsequent hypothermia will increase the postoperative oxygen demand and may endanger patients with restricted cardiopulmonary reserves. Forty patients scheduled for intra-abdominal aortic surgery and 40 patients scheduled for peripheral vascular surgery on the lower limbs were investigated using a warming blanket, humidified heated inspired anesthetic gases at 37-40 degrees C, or both these methods together. A fourth group of patients received no active warming. A warming blanket used alone gave no protection against hypothermia when compared with no active warming. In the abdominal surgical group, there was a steady fall in temperature throughout the operation if no warming method was employed. In this group the use of humidified, heated inspired gases was significantly better than no treatment after 2 h of anesthesia (P less than 0.05). The combination of humidified and heated inspired gases and a warming blanket gave significantly better heat preservation after 40 min (P less than 0.05). Patients undergoing peripheral vascular surgery had similar but smaller drops in temperature with the different types of warming procedures employed. The differences in temperature between the intra-abdominal and extra-abdominal operations were statistically significant after 3 h (P less than 0.05).     

冲洗液温度对行经皮肾镜取石术患者的临床疗效及选择素P和E的影响

目的:探讨冲洗液温度对行经皮肾镜取石术患者的临床效果以及选择素P和E的影响。方法:选择2015年5月至2017年5月本院收治的经皮肾镜取石手术患者60例为研究对象,随机分为室温组和温控组,每组30例。室温组患者术中及术后24 h室温为25℃,术中灌洗液不加温;温控组患者术中及术后24 h室温为25℃,术中灌洗液恒温加热...     

Effects of surgical site and inspired gas warming devices on body temperature during lower abdominal and thoracic surgery

To evaluate the effects of surgical site and inspired gas warming and humidifying devices on body temperature, we studied rectal, tympanic membrane, and esophageal temperature changes in 48 patients. The patients were divided into 4 groups (n = 12), according to surgical site, lower abdominal surgery and thoracic surgery, and according to the warming device used, heat and moisture exchanger (ThermoVent 600) and heated humidifier (Cascade 1). The heated humidifier was controlled to warm inspired gases to about 35°C. All body temperatures fell significantly during surgery. There was no difference in the tympanic membrane and esophageal temperature declines between the two surgical sites, but the decline in rectal temperature was larger in the lower abdominal surgery than in the thoracic surgery. At the end of surgery, all temperatures returned to the value before surgery, and the rectal and tympanic membrane temperatures even exceeded them. There was no difference between the effects of the ThermoVent 600 and Cascade 1. These results suggest that rectal temperature is influenced by the ambient temperature during lower abdominal surgery and that warming and humidifying devices for inspired gases do not prevent, but can restore the decline in body temperature during lower abdominal and thoracic surgery. The heated humidifier showed no advantage over the heat and moisture exchanger in our study.(Harioka T, Sone T, Nomura K, et al.: Effects of surgical site and inspired gas warming devices on body temperature during lower abdominal and thoracic surgery. J Anesth 6: 467–473, 1992)     

Heated humidification in major abdominal surgery

The influence of heated humidification on body temperature and postoperative shivering was studied in 30 patients undergoing major intra-abdominal surgery. In the control group (I) the anaesthetic gases, administered in a non-rebreathing system, were humidified by a sponge heat and moisture exchanger. In group II the gases were humidified and heated to 37 degrees C and in group III up to 40 degrees C. Anaesthesia, surface insulation and warming of the infusions were standardized. The temperature was registered at the lower oesophagus and the big toe. Shivering and the feeling of cold were estimated at 15 min intervals postoperatively. A good correlation was found between heat gain during the first hour of recovery, the feeling of cold and intensity of shivering. Intraoperative heat loss was minimal in all groups. Heated humidification had no statistically significant effect on the body temperatures or postoperative shivering and thus provided no additional advantage compared to the control group.     

Impact of previous abdominal surgery on colorectal laparoscopy results: a comparative clinical study

To assess the results of laparoscopic colorectal surgery in patients who have previously undergone abdominal surgery. Between November 2002 and June 2004, 86 patients underwent laparoscopic surgery for colorectal disease at our hospital. Patients were divided into 2 groups depending on whether they had previously undergone abdominal surgery (previous surgery group, n = 27) or not (nonprevious surgery group, n = 59). Data were prospectively collected for statistical analyses of demographic, clinical, and histologic variables. Groups were comparable in age, body mass index, American Society of Anesthesiologists score, diagnosis, technique performed, and tumor size and distance to anal verge. There was no difference in perioperative complication rates. A higher conversion rate was found in the previous surgery group (26.1% vs. 5.1%, P = 0.02). In patients with tumor diseases, resection evaluations were no different regarding specimen length, distal and radial resection margins, or number of lymph nodes harvested. Laparoscopic colorectal surgery has proved to be a reliable technique for patients who have previously undergone abdominal surgery, its results comparable to those obtained with patients who have not.     

胃癌术中腹腔内温热灌注化疗的临床应用

目的 探讨中晚期胃癌行根治或姑息切除联合术中腹腔内温热灌注（IPHP）化疗的无期疗效。方法 1987年10月－1997年10月间收治的中晚期胃癌71例,其中IPHP组37例,对照组34例。IPHP组在手术关腹前,使用加温灌注装置将加温的氟尿嘧啶溶液连续灌注入腹腔,腹腔内液本的温度维持在42℃－43℃之间,时间60min。结果 IPHP化疗后12例腹腔内广泛转移、腹腔种植伴腹水的患者,腹水很快消失。经治疗患者全部出院,追踪随访年生存率（51．6％）较对照组（32．3％）明显提高（P＜0．05）。结论 术中IPHP化疗临床应用安全可行。     

艾司洛尔复合瑞芬太尼对上腹部手术患者异氟醚MAC的影响

目的 探讨艾司洛尔复合瑞芬太尼对上腹部手术患者异氟醚MAC的影响.方法 拟在全麻下行上腹部手术患者100例,随机分为5组(n=20),麻醉诱导:A组仅吸人异氟醚,其他各组在吸人异氟醚的同时,静脉输注相应剂量艾司洛尔和/或瑞芬太尼,B组静脉注射负荷量艾司洛尔1mg/kg后,以250μg·kg-1·min-1静脉输注;C组静脉注射负荷量瑞芬太尼O.25μg/kg后,以O.05 gg·kg-1·min-1静脉输注;D组和E组静脉注射负荷量瑞芬太尼0.25μg/kg后,以0.05 μg·kg-1·min-1静脉输注,同时分别静脉注射负荷量艾司洛尔O.5、1 mg/kg后,分别以50、250μg·kg-1·min-1静脉输注.意识消失后,静脉注射琥珀胆碱1.5mg/kg,气管插管后机械通气,A组仅吸入异氟醚维持麻醉,其他各组同时输注与麻醉诱导时相同剂量艾司洛尔和/或瑞芬太尼.A组和B组第1例患者异氟醚呼气末浓度为1.24%,其他各组第1例患者异氟醚呼气末浓度为0.78%,根据是否发生切皮反应,采用序贯法确定下一例患者的异氟醚呼气末浓度,相邻浓度比值为10%,计算异氟醚MAC.结果 A组、B组、c组、D组和E组异氟醚MAC分别为1.24%±0.14%、1.22%±0.09%、0.77%±0.05%、0.75%±0.06%和0.60%±0.05%;C组、D组和E组异氟醚MAC低于A组(P<0.05);E组异氟醚MAC低于C组(P<0.05).结论 静脉输注艾司洛尔250μg·kg-1·min-1复合瑞芬太尼O.05μg·kg-1·min-1可使腹部手术患者异氟醚MAC降低52%.     

Comparison of peri‐operative core temperature in obese and non‐obese patients*

Our aim was to compare peri‐operative core temperatures and the incidence of hypothermia in obese and non‐obese women with active forced‐air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0–34.9 kg.m^?2) and 10 non‐obese (18.5–24.9 kg.m^?2) women received forced‐air warming on their lower limbs. At the end of surgery, the mean (SD) core temperatures were 36.7 (0.5) °C in the obese group and 36.0 (0.6) °C in the non‐obese group (p < 0.001). Only in the non‐obese group was there a significant decrease in the intra‐operative core temperature values (p < 0.001). The incidences of intra‐operative hypothermia were lower in the obese group (10%) compared with non‐obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the non‐obese group (36.2 (0.4) vs 35.6 (0.5) °C, respectively (p < 0.001)). In conclusion, obese female patients have higher peri‐operative core temperature and a lower incidence of hypothermia compared with non‐obese female patients during abdominal surgery with active forced‐air warming.