不同术中保温对胃肠术患者体温与凝血功能及手术部位感染的影响  

Effects of different intraoperative insulation methods on body temperature,coagulation,and surgical site infections in patients undergoing gastrointestinal surgery

作　　者：蔺建华[1] 王纪明[2] 许会玲[1] 段红伟[3] 朱应菊[1] 

机构地区：[1]莱芜市人民医院手术室,山东莱芜271100 [2]莱芜市人民医院麻醉科,山东莱芜271100 [3]莱芜市人民医院普外科,山东莱芜271100

出　　处：《中华医院感染学杂志》2016年第18期4176-4178,共3页Chinese Journal of Nosocomiology

基　　金：山东省医药卫生计划基金资助项目(2012039)

摘　　要：目的探讨不同术中保温对胃肠术患者体温与凝血功能及手术部位感染的影响,为胃肠手术治疗患者提供更有效的保温方法。方法选取2012年1月-2015年10月在医院就诊并行胃肠术治疗的患者240例,随机将其分为观察组和对照组,每组120例;术中对观察组患者采用盖被保温的同时使用加温毯进行双重保温,对照组患者只采用盖被方法进行保温,对比两组患者在术前、术中第30、60、90分钟以及手术结束时即刻的体温变化,低体温发生率、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)以及术中和术后的第1、3、6、12、24小时的失血量,及手术部位感染率。结果观察组患者术中的体温无明显变化,显著高于对照组(P<0.05);观察组患者在围手术期内有11例出现低体温现象,发生率为9.2%,对照组83例,发生率为69.2%,两组比较差异有统计学意义(P<0.05);观察组患者围手术期的失血量与对照组患者比较,差异均有统计学意义(P<0.05);围手术期中,观察组TT、PT以及APTT均无明显变化,与对照组比较差异有统计学意义(P<0.05);观察组患者手术部位感染率为2.5%,显著性低于对照组的16.7%,差异有统计学意义(P<0.05)。结论对胃肠手术患者而言,在术中应用加温毯能增加产热,有利于患者维持体温的稳定,降低低体温的发生率,减少围手术期患者失血量,改善凝血功能障碍以及减少手术部位感染的发生。OBJECTIVE To explore the effects of different intraoperative insulation methods on body temperature,coagulation,and surgical site infections in patients undergoing gastrointestinal surgery so as to offer the more effective insulation method for the patients undergoing the gastrointestinal surgery.METHODS A total of 240 patients who were treated in the hospital and received the gastrointestinal surgery from Jan 2012 to Oct 2015 were enrolled in the study and randomly divided into the observation group and the control group,with 120 cases in each group.The observation group was treated with covering with quilts combined with warming blanket for double insulation,while the control group was only given covering with quilts for insulation.The change of body temperature,incidence of hypothermia,thrombin time（TT）,prothrombin time（PT）,and activated partial thromboplastin time（APTT）were observed and compared between the two groups of patients before the surgery,at 30,60,90 min during the surgery,and at the end of surgery;the blood loss volume was compared during the surgery and after the surgery for 1,3,6,12,and 24hours;the incidence of surgical site infections was compared between the two groups of patients.RESULTS The intraoperative body temperature did not change significantly in the observation group,significantly higher than that in the control group（P〈0.05）.The hypothermia occurred in 11 cases in the observation group during the perioperative period,with the incidence rate 9.2%;it occurred in 83 cases in the control group,with the incidence rate 69.2%,and there was significant difference between the two groups（P〈0.05）.There was significant difference in the perioperative blood loss volume between the observation group and the control group（P〈0.05）.The TT,PT,and APTT of the observation group changed significantly during the perioperative period,as compared with the control group（P〈0.05）.The incidence of surgical site infections was 2.5%in the observation group,significantly lower t

关 键 词：保温措施 胃肠术 加温毯 凝血功能 感染 

分 类 号：R656.6[医药卫生—外科学]