七氟醚低流量麻醉对腹腔镜肾脏手术患者的体温影响  

Effects of different fresh gas flow with sevoflurane anesthesia on temperature in patients undergoing laparoscopic nephrectomy

作　　者：胡启雅 郭亚秋[1] 丁超[1] 王姿[1] 郭靖璇 齐峰[1] 

机构地区：[1]山东大学齐鲁医院,山东济南250012

出　　处：《腹腔镜外科杂志》2015年第7期503-506,共4页Journal of Laparoscopic Surgery

摘　　要：目的：低体温是麻醉期间常见的并发症之一,其机制尚不十分清楚。本研究旨在观察不同新鲜气体流量七氟醚麻醉行腹腔镜手术时对患者体温的影响。方法：选择40例行腹腔镜肾脏手术的患者,ASAⅠ～Ⅱ级,随机分为L组（新鲜气体流量为1.0 L/min）与H组（新鲜气体流量为2.0 L/min）,每组20例。室内温度维持在23℃,湿度维持在40%～60%。患者使用相同的外科覆料,输液未予加温处理。体温监测：连续监测前胸皮肤温度（chest skin temperature,Ts）、鼻咽温（nasopharyngeal temperature,Tc）,每15 min记录一次,至手术结束。术毕观察患者寒颤、躁动、术野及切口渗血等发生情况。结果：两组患者年龄、体重、手术时间、出血量、尿量、输液量等方面差异无统计学意义。与诱导后即刻相比,两组患者Tc在诱导45 min后开始下降（P〈0.05）;诱导后60 min,L组体温高于H组（P〈0.05）。两组患者诱导后45 min各时间点Ts下降差异有统计学意义（P〈0.05）;诱导后60 min,L组Ts高于H组。术毕患者寒颤、躁动及渗血发生率H组高于L组。结论：采用七氟醚低流量（1 L/min）麻醉可有效预防腹腔镜肾脏手术患者低体温的发生。Objective ：The perioperative hypothermia （core temperature 〈 36℃ ） is common after longer-lasting surgical proce- dures. The mechanisms of hypothermia are not fully understood. The aim of this study was to compare different fresh gas flow sevoflurane anesthesia for preventing intraoperative hypothermia during laparoscopic nephrectomy. Methods： Forty patients with ASA I - 11 degree, scheduled for elective laparoscopic nephrectomy, were randomly allocated into two groups （n = 20, each） ：Group L （fresh gas flow, FGF 1 L/min） and Group H （FGF 2 L/min）, indoor temperature was maintained at 23℃ and humidity remained at 40%-60%. All of the patients used the same surgical cladding material,infusion was not given the heat treatment. The nasopharyngeal temperature （Tc） and chest skin temperature （Ts） were continuously monitored every 15min after anesthetic induction until the end of surgery. Postoperative shiver, agitation and bleeding were also recorded. Results：There were no obvious differences in age ,weight,operation time,blood loss, urine output and transfusion volume between the two groups. Compared with immediately after induction,Tc in two groups declined after 45 min from induction （ P 〈 0.05 ）, Group L was significantly higher than group H after 60 rnin after anesthetic induction （ P 〈 0. 05 ）. Ts in two groups declined after 45 min after induction （P 〈 0.05） and Ts of group H were significantly lower than group L at 60 min （ P 〈 0.05 ）. Postoperative incidences of shiver, agitation and bleeding of group H were higher than those in group L. Conclusions ： Temperature is significantly declined slowly for laparoscopic nephrectomy with sevoflurane in low-flow anesthesia （1 L/min） than that in high-flow for a long time.

关 键 词：肾切除术 腹腔镜检查 体温 七氟醚 低流量麻醉 

分 类 号：R614[医药卫生—麻醉学]