风湿性心脏瓣膜择期手术患者术后体温变化特征及护理对策  

Changes of body temperature in patients after cardiac valve replacement and analysis of nursing strategy

作　　者：阳君蓉[1] 李晨[2] 

机构地区：[1]德阳市人民医院心胸外科,四川德阳618000 [2]四川大学华西医院心内科,四川成都610041

出　　处：《现代医学》2017年第8期1191-1195,共5页Modern Medical Journal

基　　金：国家自然科学基金(81300169)

摘　　要：目的:动态监测风湿性心脏瓣膜择期手术患者术后48 h内体温变化情况,分析维持体温近日节律的价值并探讨对应护理措施。方法:纳入2016年1月至11月我院收治的风湿性心脏瓣膜病、接受心脏瓣膜择期置换术的82例患者为对象,连续48 h检测患者术后体温,采用Hallberg平均余弦法拟合所有患者术后体温变化曲线,分析特征;采用Hallberg单个余弦法拟合患者个体的温度曲线并将患者划分为2组:温度变化具备节律性者纳为观察组,不具备节律性者纳为对照组。对比2组ICU停留时间、术后清醒时间、机械通气时间、住院时间,术前、术后3d时简易智能状态量表(MMSE)、医院焦虑抑郁量表(HAD)评分,总结术后体温变化特征与患者预后的关系,并探讨相应的护理对策。结果:患者总体术后体温变化呈现近日节律(P<0.05);观察组共63例患者,对照组共19例。观察组ICU停留时间、术后清醒时间、机械通气时间、住院时间均明显短于对照组,术后3 d时,观察组MMSE量表得分均明显高于对照组,HAD量表得分均明显低于对照组,上述差异均有统计学意义(P<0.05)。结论:风湿性心脏瓣膜择期手术患者术后体温保持近日节律者较多,且能够保持近日节律多伴随良好的预后,提示需要采取一定措施主动干预患者体温变化。Objective： To dynamically monitor the changes of body temperature in patients with rheumatic valvular heart disease for 48 h after cardiac valve replacement,then to analyze the value of maintaining the circadian rhythm of body temperature and to explore the corresponding nursing measures. Methods： 82 patients treated with cardiac valve replacement from January to November 2016 were involved and continuously monitor for postoperative body temperature for at least 48 hours. The characteristics of body temperature changes were analyzed by Hallberg mean cosine method,and patients were divided into observation group and control group according to their body temperature changes in circadian rhythm. The ICU stay time,postoperative awake time,mechanical ventilation time,hospitalization time,mini mental state scale（ MMSE） scores and hospital anxiety and Depression Scale（ HAD） score before and 3 d after operation were compared. The relationship between characteristics of temperature changes and prognosis of patients were summarized,and the nursing countermeasures were discussed. Results： The changes of body temperature in patients after operation showed a circadian rhythm（ P 0. 05）. There were a total of 63 patients in the observation group,and a total of 19 cases in the control group. The ICU stay time,postoperative awake time,mechanical ventilation time,hospitalization time in the observation group were all significantly shorter than those in the control group. 3 d after operation,the average MMSE score in the observation group was significantly higher than that in the control group,and the average HAD score in the observation group was significantly lower than that in the control group. The differences above were statistically significant（ P 0. 05）. Conclusion： Most patients after cardiac valve replacement can maintain circadian rhythm in body temperature changes,and they are more likely to have good prognosis,suggesting the need to take certain measures to keep circadian rhythm in body temperatu

关 键 词：风湿性心脏瓣膜病 心脏瓣膜置换术 体温 生物节律 余弦法 

分 类 号：R473.5[医药卫生—护理学]