不同体温管理策略对老年单肺通气患者脑氧饱和度变化率和术后谵妄的影响  

Effects of Different Body Temperature Management Strategies on Cerebral Oxygen Saturation Change Rate and Postoperative Delirium among Elderly Patients with One-Lung Ventilation

作　　者：王静玉[1] 符聪[1] 荀玉月 邓曙雨 方平[1] WANG Jingyu;FU Cong;XUN Yuyue;DENG Shuyu;FANG Ping(Anesthesia and Operation Center,Li Huili Hospital,Ningbo Medical Center,Ningbo 315000,Zhejiang Province,China)

机构地区：[1]浙江省宁波市医疗中心李惠利医院麻醉手术中心,浙江宁波315000

出　　处：《解放军护理杂志》2021年第8期27-30,92,共5页Nursing Journal of Chinese People's Liberation Army

基　　金：浙江省医药卫生科技计划(2021KY310);宁波市医学科技计划项目(2017A56)。

摘　　要：目的探讨不同体温管理策略对老年单肺通气患者脑氧饱和度(regional saturation of cerebral oxygenation,rScO_(2))变化率和术后谵妄(postoperative delirium,POD)的影响。方法2019年4月至2020年4月,便利抽样法选取宁波市某三级甲等医院行胸腔镜下肺叶切除术的96例老年患者为研究对象,根据随机数字表法,将患者分为中档组(M组)、综合组(Z组)和高档组(H组),各32例。三组患者在常规保温基础上实施不同的体温管理策略。比较三组入室(T0)、麻醉后(T1)、单肺通气30 min(T2)、60 min(T3)、90 min(T4)、手术结束(T5)的生命体征、rScO_(2)变化率及苏醒期躁动发生率、视觉模拟(visual analogue scale,VAS)评分和POD的发生率。结果三组体温随时间延长逐渐下降,T2~T5的体温Z组和H组均高于M组(均P<0.05)。三组单肺通气后rScO_(2)呈下降趋势至术毕接近基线水平,T3~T4的rScO_(2)值由高到低,依次为Z、H、M组(均P<0.05)。三组rScO_(2)变化率、POD例数及苏醒期躁动发生率由高到低分别为M、H、Z组(均P<0.05)。患者体温变化率、rScO_(2)变化率与POD三者之间行相关性分析均呈正相关。结论充气式保温毯设为43℃1 h后改为38℃的体温管理策略可有效降低rScO_(2)变化率和POD发生率。To investigate the effects of different body temperature management strategies on cerebral oxygen saturation change rate and postoperative delirium(POD)among elderly patients with one-lung ventilation.Methods A total of 96 patients with thoracoscopic lobectomy were selected and divided into medium(M)group,comprehensive(Z)group and high-grade(H)group.The vital signs,regional saturation of cerebral oxygenation(rScO_(2)),incidence of agitation during recovery period,visual analogue scale(VAS)score and incidence of POD were compared among the three groups after entering the operation room(T0),after anesthesia(T1),one-lung ventilation for 30min(T2),60min(T3),90min(T4),and at the end of operation(T5).Results In the three groups,patients’body temperature decreased gradually with the extension of time.Patients’body temperature at T2 to T5 in the Group Z and Group H were higher than those in the Group M(all P<0.05).After one-lung ventilation,the rScO_(2) in the three groups showed a downward trend and approached the baseline level at the end of operation.The order from the highest rScO_(2) to the lowest rScO_(2)at T3 and T4 was the Group Z,the Group H,and the Group M(all P<0.05).The order of the change rate of body temperature and rScO_(2),the incidence of POD and the incidence of agitation during recovery period was the Group M,the Group H,and the Group Z(from the highest to the lowest)(all P<0.05).There were positive correlations among the change rate of body temperature,the change rate of rScO_(2) and the incidence of POD.Conclusions The change rate of rScO_(2) and the incidence of POD can be effectively reduced when the temperature of inflatable insulation blanket is changed to 38℃after being set at 43℃for one hour.

关 键 词：体温 老年 脑氧饱和度 术后谵妄 单肺通气 

分 类 号：R472.3[医药卫生—护理学]