综合保温措施对胸外科低BMI患者体温及应激指标的影响  

Effect of comprehensive thermal insulation measures on body tempreture and stress index in patients with low body mass index of thoracic surgery

作　　者：冯立[1] 张笑萍[1] 于丽[1] 陶仁海[1] 朱琳玉[1] 杨君骏[1] 付建峰[2] 刘庆熠[3] Feng Li;Zhang Xiaoping;Yu Li;Tao Renhai;Zhu Linyu;Yang Junjun;Fu Jianfeng;Liu Qingyi(Operating Department,the 4th Hospital of Hebei Medical University,Shijiazhuang 050011,China;Anesthesiology Department,the 4th Hospital of Hebei Medical University,Shijiazhuang 050011,China;Thoracic Surgery Department,the 4th Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院手术室,石家庄050011 [2]河北医科大学第四医院麻醉科,石家庄050011 [3]河北医科大学第四医院胸外科,石家庄050011

出　　处：《中华现代护理杂志》2019年第30期3922-3926,共5页Chinese Journal of Modern Nursing

基　　金：河北省科技成果推广课题(20170748)。

摘　　要：目的探讨低BM(I BMI<18.5 kg/m^2)胸外科患者术中体温变化的规律及护理干预的效果.方法选取2016年6月—2018年12月于河北医科大学第四医院手术室接受胸外科手术的60例低BMI患者作为研究对象,将其随机分为观察组和对照组,每组各30例.另外选取同期住院接受胸外科手术的30例正常BM(I 18.5~23.0 kg/m^2)患者作为正常组.观察组于术中采取综合性保温措施,对照组、正常组采取常规保温措施.比较3组患者入室、消毒、体腔探查、切取标本、关胸、缝皮、出室各时间点的体温情况,术中不良反应发生情况,以及手术前及手术结束时外周血凝血指标及乳酸水平、外周血炎性因子水平.结果入室时3组患者体温比较,差异无统计学意义(P>0.05).手术中3组患者的体温均出现下降,从关胸开始有所恢复,3组患者关胸、缝皮、出室体温比较差异均有统计学意义(P<0.05).观察组术中的不良反应发生率低于对照组和正常组,差异有统计学意义(P<0.05);对照组和正常组的不良反应发生率比较,差异无统计学意义(P>0.05).入室时观察组、对照组的凝血及应激指标与正常组比较,差异有统计学意义(P<0.05);观察组、对照组的凝血、乳酸及应激指标比较,差异无统计学意义(P>0.05).3组的凝血、乳酸及应激指标术后与术前比较,差异有统计学意义(P<0.05).手术前后的白介素-6(IL-6)水平差异有统计学意义(F时间=134.241,P<0.001);处理和时间之间存在交互作用,差异有统计学意义(F交互=12.202,P<0.001).3组的白介素-10(IL-10)水平组间差异有统计学意义(F组间=7.792,P<0.001);手术前后的IL-10水平差异有统计学意义(F时间=112.121,P<0.001);处理和时间之间存在交互作用,差异无统计学意义(F交互=2.990,P=0.055).结论与正常BMI的胸外科手术患者比较,低BMI患者术前存在凝血及应激指标异常,更易出现术中血压下降及不良反应.综合性的术中保温措施�Objective To investigate the changes of body temperature and the effect of nursing intervention in patients with low body mass index(BMI<18.5 kg/m^2)during thoracic surgery.Methods:Sixty patients with low BMI who underwent thoracic surgery in the Operating Department of the 4th Hospital of Hebei Medical University from June 2016 to December 2018 were randomly divided into observation group and control group,with 30 cases in each group.In addition,30 patients with normal BMI(18.5-23.0 kg/m^2)who underwent thoracic surgery in the same period were selected as the normal group.The observation group adopted comprehensive thermal insulation measures during the operation,and the control group and the normal group adopted routine insulation measures.The patient's body temperature of three groups was compared at each time point:entering operation room,disinfection,body cavity exploration,cutting specimens,closing the chest,suture skin and exiting operation time.the occurrence of adverse reactions during surgery,the blood coagulation index and lactic acid in the peripheral blood before and at the end of surgery,and the peripheral blood inflammatory factor levels were also compared.Results:There were no significant differences in body temperature between the three groups(P>0.05).During the operation,the body temperature of the three groups decreased,and the recovery from the chest was restored.There were significant differences in body temperature between the three groups(P<0.05)at the time point:closing the chest,suture skin and exiting operation room.The incidence of adverse reactions in the observation group was lower than that in the control group and the normal group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the control group and the normal group(P>0.05).The coagulation and stress indexes of the observation group and the control group were significantly different from those of the normal group(P<0.05).There was no significa

关 键 词：体重指数 胸外科 体温 凝血功能 应激指标 

分 类 号：R47[医药卫生—护理学]