上下联合保温对全腔镜三切口食管癌根治术患者体温及复苏影响的研究实践  

Research practice of using two heating blankets in combination to affect intraoperative temperature and postoperative resuscitation in patients undergoing endoscopic three-incision radical resection of esophageal cancer

作　　者：柏艳芳[1] 李明天[1] 詹舟茹 覃惠英[2] Bai Yanfang;Li Mingtian;Zhan Zhouru;Qin Huiying(Department of Operating Room,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;SunYat-sen University School of Nursing,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心手术麻醉科,广州510060 [2]中山大学护理学院,广州510060

出　　处：《中国实用护理杂志》2020年第33期2600-2606,共7页Chinese Journal of Practical Nursing

基　　金：中山大学护理青年人才培育基金(N2019Y10)。

摘　　要：目的比较3种加温方式对全腔镜下三切口食管癌根治术患者术中体温及术后复苏各指标的影响。方法将全麻下行三切口食管癌根治术患者150例采用随机数字表法分为3组(身下组48例、身上组48例及联合组49例),分别使用身下型加温毯、身上型加温毯、联合身上身下型加温毯,记录并比较3组患者入室时、麻醉诱导时、手术开始时及开始后每30分钟、手术结束时各时间点的鼻咽体温,比较3组患者低体温发生率、患者温度舒适感、寒战躁动次数、寒战评分及术后复苏相关指标情况。结果手术期间患者体温波动呈现"两降两升"过程,体温下降分别在麻醉诱导后及开胸转开腹时出现。联合组体温下降幅度低,上升速度快,从麻醉诱导开始后各时间点平均体温高于身上组及身下组(均P<0.05),低体温发生率为4.08%(2/49),低于身上组的22.92%(11/48)及身下组的18.75%(9/48),差异有统计学意义(χ^2值为7.397,P=0.025)。身下组在麻醉诱导时及手术结束时平均体温分别为(36.52±0.18)、(36.31±0.35)℃,高于身上组(36.44±0.15)、(36.13±0.32)℃(t值为2.393,3.723,P<0.05)。联合组温度舒适感得分为(7.81±0.52)分,高于另两组(F值为19.962,P<0.01),复苏期寒战次数、躁动次数、寒战评分低于其他2组(F值为8.186、6.705、4.051,均P<0.05),拔管时间及完全清醒时间分别为(15.90±2.97)、(31.47±4.42)min,均低于另两组(F值为69.094、114.549,均P<0.01)。结论在全腔镜三切口食管癌根治术中联合加温可快速实现患者体温上升,以抵消患者术中体温下降阶段的热量丢失,有利于维持患者术中体温平稳,减少了术中低体温、术后寒战和躁动的发生,提高了患者的温度舒适感,缩短了拔管时间及清醒时间,有利于促进患者术后复苏,从而减少术后低体温相关并发症,值得推广使用。Objective To compare the effects of three heating methods on intraoperative temperature and postoperative resuscitation in patients undergoing three-incision radical resection of esophageal cancer under full endoscope.Methods A total of 145 patients undergoing endoscopic three-incision radical resection of esophageal cancer were randomized to receive forced-air warming respectively on the under-body blanket(UB group,n=48),over-body blanket(OB group,n=48),underbody blanket in combination with over-body blanket(Combined group,n=49).The nasopharyngeal temperature were recorded at the time of entering the operating room,at the beginning of the intubation,at the beginning of the operation and every 30min after the operation,at the end of the operation.The incidence of hypothermia,hypothermia related adverse reactions and postoperative resuscitation indicators of the three groups were compared.Results During the operation,the patients'temperature fluctuation showed two processes of decrease and two processes of increase.The temperature of Combined group showed a lower fall and a faster rise.The average temperature of the Combined group were higher than the other two group at each time point from the beginning of the intubation,the incidence of hypothermia was 4.08%(2/49),which was lower than the OB group[22.92%(11/48)]and the UB group[18.75%(9/48)],The difference was statistically significant(χ^2 value was 7.397,P=0.025).The temperature of the UB group was(36.52±0.18),(36.31±0.35)℃at the beginning of intubation and at the end of the operation,respectively,which were higher than that of the OB group(36.44±0.15),(36.13±0.32)℃(t value was 2.393,3.723,P<0.05).The temperature comfort score of the combined group was 7.81±0.52,higher than that of the other two groups(F value was 19.962,P<0.01),and the scores of chills,agitation and chills in the recovery period were lower than that of the other two groups(F value was 8.186,6.705,4.051,all P<0.05).The extubation time and the waking time of the combined group was(15.9

关 键 词：低体温 充气式加温毯 联合保温 三切口 食管癌根治术 

分 类 号：R473.73[医药卫生—护理学]