五种保温措施对开腹手术患者体温的影响

目的探讨不同保温措施对开腹手术患者体温的影响,以选择适宜的术中保温措施。方法将90例择期行开腹手术患者随机分为输液输血加温组、身体包裹组、湿敷料加温组、冲洗液加温组、保温毯组及对照组,每组15例。术中均常规加盖棉被,对照组不再采用其他保温措施。输液输血加温组将液体及血液采用适宜的方法加温至37℃再输入体内;身体包裹组将患者的双上肢,双大腿下1/3至足部及肩颈部用棉垫包裹;湿敷料加温组术中湿敷料用37℃温盐水浸湿后使用;冲洗液加温组把冲洗液加温至37℃再用于手术野冲洗;保温毯组术前将电热保温毯温度设定为38.5℃铺于手术床。结果身体包裹组鼻咽温、肛温均有下降但不显著(均P>0.05);保温毯组鼻咽温和肛温手术结束时较入室时升高(均P<0.05);输液输血加温组、冲洗液加温组肛温下降显著(均P<0.05),湿敷料加温组鼻咽温、肛温均显著下降(均P<0.01)。结论开腹手术中,为维持患者的正常体温,提高围术期患者的安全性,首选保温毯保温,次选身体包裹保温。

Five temperature-keeping measures for patients undergoing open abdominal surgery: comparision of patients' body temperature

Objective To study the effect of five different insulation measures on body temperature of patients receiving open abdominal surgery.Methods A total of 90 patients scheduled for elective abdominal surgery were randomized into 5 experimental groups(A,B,C,D,and E) and control group,with 15 cases in each group.During the surgery,all the patients were covered with quilts.Group A were administered with heated fluid of 37℃ and transfused with heated blood of 37℃.In group B,patients′upper limbs,1/3 of lower limbs,feet,shoulder and neck were covered with cotton pads.In group C,all the moist dressings were immersed into 37℃ saline before they were applied to patients.In group D,flushing fluid was heated to 37℃ before it was used to irrigate the surgical sites.In group E,electric blankets were used to cover the surgical bed which allowed patients to lie on with the temperature being set to 38.5℃.The control group didn′t receive extra temperature-keeping measures.Results In group B,patients′nasopharygeal temperature and anal temperature decreased as time went by(P>0.05 for both);by the end of the surgery,group E patients′nasopharygeal temperature and anal temperature were significantly higher than at entrance to the operating room(P<0.05 for both).Group A and group D had poorer temperature-keeping effect while group C had none temperature-keeping effect.Conclusion During an open abdominal surgery,in order to maintain normal body temperature of patients and to improve perioperative safety and quality of perioperative care,an electric blanket is the first choice,followed by wrapping the body with cotton pads.