主动体温干预对老年患者经尿道前列腺电切术围术期凝血功能的影响  

Study on the effect of active body temperature intervention on coagulation function in elderly patients with transurethral resection of prostate

作　　者：李帅[1,2] 张耀文 申磊[1,2] 齐敦益 

机构地区：[1]江苏省麻醉学重点实验室,江苏徐州221009 [2]徐州医科大学附属医院麻醉科,江苏徐州221000

出　　处：《临床和实验医学杂志》2017年第20期2053-2057,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的观察主动体温干预对老年患者经尿道前列腺电切术(T_URP)围术期凝血功能的影响。方法择期行T_URP患者50例,随机分为两组,每组25例,记为主动体温干预组(W组)和常规保温组(N组)。W组患者除覆盖外科铺巾外,入室即使用充气式暖风机;N组患者常规覆盖外科铺巾,不使用主动升温措施。记录麻醉诱导时(T_0)、手术开始后60 min(T_1)、手术结束时(T_2)患者的鼻咽温度,并监测T_0、T_1、T_2的血栓弹力图(T_EG)、血细胞比容(Hct)、血红蛋白(Hb)和常规凝血功能结果(PT_、APT_T_、Fib)。记录两组患者麻醉时间,术中输液量和冲洗液量。结果 (1)两组患者T_0均未发生低体温,T_1、T_2体温均低于T_0(P<0.05);W组患者T_1、T_2体温均高于N组患者(P<0.05)。(2)两组患者T_0T_EG各项指标均无异常,T_1、T_2与T_0相比R、K先降低后升高,α、CI先升高后降低,MA逐渐降低(P<0.05);W组患者T_1、T_2时与N组相比R、K较小,α、MA、CI较大(P<0.05)。(3)两组患者T_0Hct、Hb和常规凝血指标均无异常,T_1、T_2与T_0相比Hct、Hb逐渐下降,PT_、APT_T_逐渐上升,Fib先升后降(P<0.05);W组患者T_1时与N组相比Fib值较大,PT_、APT_T_值较小(P<0.05),T_2时与N组相比Hct、Hb、Fib值较大,PT_、APT_T_值较小(P<0.05)。结论主动体温干预能有效防止围术期低体温的发生,改善老年患者T_URP围术期凝血功能,进而保障患者生命安全,值得推广。Objective To observe the effect of active body temperature intervention on coagulation function of elderly patients with transurethral resection of prostate. Methods Fifty patients with transurethral resection of prostate were randomly divided into two groups： group W and group N. Patients in group W were not only covered with surgical towel,but also protected with forced air-warming blanket. Patients in group N were covered with surgical towel,without other active warming measures. The nasopharyngeal temperature was recorded at the time of anesthesia induction（ T0）,60 min after the start of surgery（ T1） and at the end of surgery（ T2）. TEG,PT,APTT,Fib,Hct and Hb were examined at the time points of T0,T1 and T2. The duration for anesthesia,volume of intraoperative transfusion and amount of flushing fluid in patients of these two groups were recorded. Results（1）There was no hypothermia occurred in both groups at T0. The body temperature of patients in these two groups at T1 and T2 were lower than that at T0 with surgery procedure（ P〈0. 05）. The temperature of patients in group W was statistically higher than that of patients in group N at T1 and T2（ P〈0. 05）.（2）TEG in patients of these two groups was not abnormal at T0. Following the proceeding of operation,R and K were decreased at first,then increased,α,CI was increased at first and then decreased,and MA was gradually decreased（P〈0. 05）. In comparison with group N,R and K were smaller,α,MA and CI were larger in group W at T1 and T2（ P〈0. 05）.（3）Hct,Hb and routine coagulation function were not abnormal at T0. With the proceeding of surgery,Hct and Hb were gradually decreased,PT and APTT were gradually increased,Fib was increased at first,then decreased（ P〈0. 05）. In comparison with group N,PT and APTT were smaller,and Fib was larger in group W at T1（ P〈0. 05）. In comparison with group N,PT and APTT were smaller,Hct,Hb and Fib were larger in group W at T2（ P〈0. 05）. Conclusion Active body tempera

关 键 词：经尿道前列腺电切术 主动体温干预 鼻咽温度 凝血功能 

分 类 号：R614[医药卫生—麻醉学]