体温保护策略对肺癌手术患者凝血功能的影响

目的 探讨肺癌手术中体温保护策略对于患者凝血功能的影响,以及血栓弹力图(TEG)对凝血功能的检测价值.方法 收集自2011年10月-2015年10月期间行肺癌根治术的择期手术患者详细临床资料.入组患者采用随机数字表法分成观察组(主动保温组)和对照组(常规保温组).比较两组患者的一般资料、各时间点的鼻咽温度、凝血功能指标、术后寒战及苏醒时间.结果 共入组患者93例,其中观察组患者45例,对照组48例.在T3、T4、T5、T6时间点,观察组患者的鼻咽温度均高于对照组患者(P＜0.05);在术中、术后时间点,观察组患者的激活全血凝血时间(ACT)、K明显低于对照组(P＜0.05),而α、MA值则明显高于对照组(P＜0.05);观察组患者的低体温、术后寒战发生率及苏醒时间均显著低于对照组(P＜0.05).结论 温度保护策略能够显著降低肺癌手术患者围手术期低体温的发生率,并改善患者的凝血功能.

The impact of temperature protection strategy on the coagulation function in patients undergoing lung cancer surgery LYU Dezhen,ZHAO Yu,TENG Chengling (Department of Anesthesiology,Nanjing General Hospital of Nanjing Military Command,Nanjing,Jiangsu 210002,China)Abstract:Objective

Objective To discuss the impact of temperature protection strategy on the coagulation function in patients undergoing lung cancer surgery and the detective value of thrombelastogram in the coagulation function.Methods Clinical data of patients undergoing elective radical lung cancer surgeries from 2011 to 2015 was collected.Patients were randomly divided into two groups according to the treatment:observe group (active warming group) and control group (traditional warming group).The clinical data,nasopharyngeal temperature at different time points,blood coagulation function index,postoperative chills and awakening time in two groups were compared.Results A total of 93 patients were analyzed retrospectively,including 45 in observe group and 48 in control group.The nasopharyngeal temperatures at time points of T3,T4,T5 and T6 in observe group were higher than those in control group (P ＜ 0.05).Patients in observe group had higher levels of ACT,K and lower levels of α,MA during and after the surgery than control group (P ＜ 0.05).The incidence of low temperature,postoperative chills and the awaking time in observe group were significantly lower than control group.Conclusions The temperature protection strategy can decrease the incidence of perioperative low temperature and improve the coagulation function in patients undergoing elective radical lung cancer surgeries.