综合保温措施对大面积烧伤切痂植皮术患者围手术期治疗效果的影响  

Influence of comprehensive incubational measures on the perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting

作　　者：古兰 王玲 苗文 程沙沙 戴娇娇 Gu Lan;Wang Ling;Miao Wen;Cheng Shasha;Dai Jiaojiao(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤杂志》2020年第11期1060-1064,共5页Chinese Journal of Burns

摘　　要：目的探讨规范的综合保温措施对大面积烧伤切痂植皮术患者围手术期治疗效果的影响。方法2017年1月—2018年11月,空军军医大学第一附属医院收治的50例大面积烧伤切痂植皮术患者符合本研究入选标准,对其进行回顾性队列研究。根据当时的保温措施,将2017年1—10月收治的围手术期接受常规保温的20例患者[男14例、女6例,年龄(33.5±5.2)岁]设为常规保温组;将2017年11月—2018年11月收治的围手术期接受规范综合保温的30例患者[男23例、女7例,年龄(35.8±1.4)岁]设为综合保温组,主要在从术前重症监护病房(ICU)准备及转运至手术室、术前手术室准备、术中手术室处理、术后手术室转运至ICU 4个环节控制体温。统计2组患者入手术室体温和术中低体温的持续时间,术中出血量,术后苏醒时间,术后寒战、水疱、溃疡发生情况及术后10 d创面愈合率。对数据行两独立样本t检验、χ2检验。结果(1)综合保温组患者入手术室体温为(36.3±0.4)℃,明显高于常规保温组的(35.6±0.4)℃,t=6.658,P<0.01;术中低体温持续时间为(205±38)min,明显短于常规保温组的(234±42)min,t=2.564,P<0.05。(2)综合保温组患者术中出血量为(323±114)mL,明显少于常规保温组的(490±162)mL,t=4.272,P<0.01;术后苏醒时间为(36±8)min,明显短于常规保温组的(49±17)min,t=3.229,P<0.01。(3)综合保温组患者术后寒战发生率明显低于常规保温组(χ2=28.626,P<0.01),2组患者术后水疱、溃疡发生率相近。(4)术后10 d综合保温组患者创面愈合率为(78.08±0.06)%,明显高于常规保温组的(71.03±0.08)%,t=3.694,P<0.01。结论规范的综合保温措施可以有效提高患者入手术室体温,缩短术中患者低体温持续时间,减少术中出血量和术后并发症,缩短术后苏醒时间,提高创面愈合率。Objective To explore the influence of standardized and comprehensive incubational measures on perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting.Methods From January 2017 to November 2018,50 patients with extensive burn who underwent escharectomy and skin grafting in the First Affiliated Hospital of Air Force Medical University and met the inclusion criteria of this study,were recruited in this retrospective cohort study.According to the incubational measures at that time,20 patients(14 males and 6 females,aged(33.5±5.2)years)who received routine incubation during the perioperative period from January to October 2017 were set as routine incubation group,and 30 patients(23 males and 7 females,aged(35.8±1.4)years)who received standardized comprehensive incubational measures during the perioperative period from November 2017 to November 2018 were set as comprehensive incubation group.Their body temperature was controlled mainly in 4 stages:preoperative preparation and transfer from intensive care unit(ICU)to operating room,preoperative preparation in operating room,intraoperative operating room management,as well as postoperative transfer from operating room to ICU.The initial body temperature in operating room and intraoperative hypothermia duration,intraoperative blood loss,postoperative recovery time,postoperative chill,blister,and ulcer,and wound healing rate on post operation day(POD)10 were recorded and calculated.Data were statistically analyzed with two independent samples t test and chi-square test.Results(1)The initial body temperature in operating room of patients in comprehensive incubation group was(36.3±0.4)℃,which was significantly higher than(35.6±0.4)℃in routine incubation group,t=6.658,P<0.01;the intraoperative duration of hypothermia was(205±38)min,which was significantly shorter than(234±42)min in routine incubation group,t=2.564,P<0.05.(2)The intraoperative blood loss of patients in comprehensive incubation group was(323±114)mL,which wa

关 键 词：烧伤 皮肤移植 体温调节 围手术期护理 

分 类 号：R619+.6[医药卫生—外科学] R364.5[医药卫生—临床医学]