围术期全程闭环体温管理系统预防老年股骨颈骨折患者低体温的效果  

Effect of perioperative whole-course closed-loop temperature management system in the prevention of hypothermia in elderly patients with femoral neck fracture

作　　者：张董瑜 冯琪 邵长会 黄维艳 欧珊[2] Zhang Dongyu;Feng Qi;Shao Changhui;Huang Weiyan;Ou Shan(Clinical Medical College of Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Department of Anesthesiology,Chengdu First People's Hospital,Chengdu 610041,China)

机构地区：[1]成都中医药大学临床医学院,610075 [2]成都市第一人民医院麻醉科,610041

出　　处：《中华创伤杂志》2021年第12期1119-1125,共7页Chinese Journal of Trauma

基　　金：成都市医学科研课题(2020026)。

摘　　要：目的探讨围术期全程闭环体温管理系统预防老年股骨颈骨折患者低体温的效果。方法采用回顾性病例对照研究分析2020年1月至2020年12月成都市第一人民医院收治的120例老年股骨颈骨折患者临床资料,其中男48例,女72例;年龄60~79岁[(68.3±5.0)岁]。患者均接受人工全髋关节置换术治疗。40例采用全程闭环体温管理系统进行保温(闭环组),40例采用医用加温垫进行保温(保温组),40例采用常规棉被进行保温(对照组)。记录三组佩戴体温传感器8 min(T0)、麻醉诱导时(T1)、麻醉诱导后30 min(T2)、麻醉诱导后60 min(T3)、术毕(T4)及进入麻醉恢复室(PACU)20 min时(T5)的核心体温。比较三组术前和T4时凝血酶时间(TT)、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)。比较三组术中低体温发生率、PACU期间寒颤发生率、手术部位感染发生率、拔管时间(停药至拔除气管导管)、住院时间(手术当天至出院时间)及使用设备相关的不良反应。结果T0时三组核心体温差异无统计学意义(P>0.05)。T1时闭环组核心体温[(36.61±0.28)℃]高于保温组[(36.45±0.28)℃]和对照组[(36.44±0.27)℃](P<0.05),保温组和对照组核心体温差异无统计学意义(P>0.05);T2~T5时闭环组核心体温[(36.46±0.28)℃、(36.40±0.30)℃、(36.45±0.37)℃、(36.50±0.27)℃]高于保温组[(36.32±0.31)℃、(36.24±0.26)℃、(36.28±0.30)℃、(36.24±0.31)℃]和对照组[(36.12±0.30)℃、(35.98±0.28)℃、(35.73±0.31)℃、(35.81±0.32)℃](P<0.05),保温组核心体温高于对照组(P<0.05)。T1时闭环组核心体温较T0时升高(P<0.05),保温组和对照组核心体温与T0时比较,差异无统计学意义(P>0.05)。T2~T5时闭环组核心体温与T0时比较,差异无统计学意义(P>0.05),保温组和对照组核心体温较T0时降低(P<0.05)。T1~T5时闭环组核心体温均在设置的目标温度范围内。术前三组TT、PT、APTT差异无统计学意义(P>0.05)。T4时闭环�Objective To explore the effect of perioperative whole-course closed-loop temperature management system for prevention of hypothermia in elderly patients with femoral neck fracture.Methods A retrospective case-control study was conducted to analyze the clinical data of 120 elderly patients with femoral neck fracture admitted to Chengdu First People's Hospital from January 2020 to December 2020.There were 48 males and 72 females,aged 60-79 years[(68.3±5.0)years].All patients underwent total hip arthroplasty.Heat warming with the whole-course closed-loop temperature management system was applied in 40 patients(closed-loop group),with the medical heating mattress in 40 patients(heat preservation group),and with the quilt in 40 patients(control group).The core body temperature of the three groups was recorded 8 minutes after wearing the temperature sensor(T0),immediately after induction of anesthesia(T1),30 minutes after induction of anesthesia(T2),60 minutes after induction of anesthesia(T3),at the end of surgery(T4),and 20 minutes after entering the postanesthesia care unit(PACU)(T5).The thrombin time(TT),prothrombin time(PT)and activated partial thromboplastin time(APTT)were compared among groups before operation and at T4.The incidence of intraoperative hypothermia,incidence of shivering during PACU,incidence of surgical site infection,extubation time(from the day of drug withdrawal to the time of tracheal tube removal),length of hospital stay(from the day of operation to the time of discharge)and adverse reactions related to the devices were compared among groups.Results There was no statistically significant difference in core body temperature among three groups at T0(P>0.05).The core body temperature in closed-loop group[(36.61±0.28)℃]was higher than that in heat preservation group[(36.45±0.28)℃]and control group[(36.44±0.27)℃]at T1(P<0.05),but no statistically significant difference was found in core body temperature between heat preservation group and control group(P>0.05).The core body temperature

关 键 词：老年 股骨颈骨折 低温 围手术期 全程闭环体温管理 

分 类 号：R614[医药卫生—麻醉学]