下肢骨折患者术中使用主动体温保护对凝血功能及出血的影响  

Influence of active body temperature protection on coagulation function and bleeding in patients with lower extremity fractures

作　　者：查丽[1] 胡希希 ZHA Li;HU Xixi(Operating Room,Jiangyin Hospital of Traditional Chinese Medicine,Jiangyin Jiangsu 214400,China)

机构地区：[1]江阴市中医院手术室,江苏江阴214400

出　　处：《临床与病理杂志》2022年第6期1430-1436,共7页Journal of Clinical and Pathological Research

摘　　要：目的:探讨主动体温保护应用于下肢骨折手术患者中对凝血功能及出血的效果。方法:选择2019年10月至2021年10月江阴市中医院收治的择期行下肢骨折切开复位内固定手术的患者104例,随机分为2组,各52例。对照组仅使用手术巾覆盖胸腹部,室温设置为22℃,使用室温液体输注与冲洗;观察组使用3M充气式保温毯覆盖胸腹部,并用手术巾隔开皮肤,设置目标体温为38℃,室温术前设置为26℃,手术开始时设置为22℃,使用37℃液体输注与冲洗。对比2组各时间点耳温、纤维蛋白形成时间(R)值、血凝块生成时间(K)值、最大振幅(maximum amplitude,MA)水平、术中失血量、24h引流量、拔管时间、首次下床活动时间、住院时间及手术前后凝血功能、术后并发症发生率情况。结果:观察组手术开始后1h、手术结束后1h的耳温高于对照组(P<0.05);观察组手术开始后1h、手术结束后1h的R值、K值低于对照组,MA水平高于对照组(P<0.05);观察组术中失血量、24h引流量低于对照组,拔管时间、首次下床时间、住院时间短于对照组(P<0.05);观察组活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)高于对照组,纤维蛋白原(fibrinogen,Fbg)低于对照组(P<0.05);观察组术后总并发症发生率与对照组相比,差异无统计学意义(P>0.05)。结论:主动体温保护应用于下肢骨折手术患者中可改善体温及凝血功能,减少术中失血量及24 h引流量,且并发症少,安全可靠。Objective:To investigate the effect of active body temperature protection on coagulation function and bleeding in patients with lower extremity fracture surgery.Methods:A total of 104 patients with elective open reduction and internal fixation of lower extremity fractures admitted to Jiangyin Hospital of Traditional Chinese Medicine from October 2019 to October 2021 were selected and randomly divided into two groups,52 cases in each group.The control group only covered the chest and abdomen with a surgical towel,the room temperature was set to 22℃,and the room temperature liquid was infused and rinsed;the observation group was covered with a 3M inflatable thermal blanket to cover the chest and abdomen,and the skin was separated with a surgical towel,and the target body temperature was set at 38℃.The room temperature was set to 26℃before surgery and 22℃at the beginning of the operation,and 37℃was used for liquid infusion and flushing.The ear temperature,R value,K value,maximum amplitude(MA)level,intraoperative blood loss,24-h drainage volume,extubation time,first ambulation time,hospital stay,coagulation function before and after surgery,and postoperative complications were compared between the two groups at each time point rate situation.Results:The ear temperature of the observation group was higher than that of the control group at 1 hour after the operation and 1 hour after the operation(P<0.05).Compared with the control group(P<0.05);the intraoperative blood loss and 24-h drainage volume of the observation group were lower than those of the control group,and the extubation time,the first time to get out of bed,and the length of hospital stay were shorter than those of the control group(P<0.05);the activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)of the observation group were higher than those of the control group,and fibrinogen(Fbg)was lower than that of the control group(P<0.05);there was no significant difference in the incidence of postoperative complications b

关 键 词：主动体温保护 下肢骨折 耳温 凝血功能 失血量 并发症 

分 类 号：R472.3[医药卫生—护理学]