加温联合目标导向液体治疗对肝包虫病患者围手术期体温及内稳态的影响  

Effects of fluid heating combined with target-directed fluid therapy on perioperative body temperature and homeostasis in patients with hepatic echinococcosis

作　　者：马文涓 陈丽丽 李丽[1,2] MA Wenjuan;CHEN Lili;LI Li(School of Nursing,Xinjiang Medical University,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Operation Room,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学护理学院,乌鲁木齐830054 [2]新疆医科大学第一附属医院手术室,乌鲁木齐830054

出　　处：《新疆医科大学学报》2023年第2期215-221,共7页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区卫生健康扶贫工作优秀适宜技术推广项目(SYTG-Y202029)。

摘　　要：目的探讨加温联合目标导向液体治疗(GDFT)对肝包虫病患者围手术期体温、内稳态及凝血功能的影响。方法将2021年8-12月在新疆医科大学第一附属医院收治的64例行肝包虫病行肝叶切除术患者作为研究对象,采用随机数字表法分为常规组和联合组,每组32例。常规组术中采用常规液体管理,使用保温毯保温,腹腔冲洗液加温至37℃;联合组在常规组的基础上采用目标导向液体治疗同时采用输液输血加温仪对术中输入的液体、血液加温至37℃。比较两组患者围手术期鼻咽温、内稳态和术前、术后1 d凝血功能指标的差异。结果联合组围手术期鼻咽温维持在正常水平且未出现术中低体温;术中动脉血酸碱度(pH)、碱剩余(BE)明显高于常规组(P<0.05),血糖(GLU)明显低于常规组(P<0.05);术后凝血功能指标血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血酶原时间(TT)短于常规组,纤维蛋白原(FIB)水平低于常规组(P<0.05)。结论在目标导向液体治疗的基础上对术中输液输血及冲洗液进行加温,能够有效维持肝包虫肝叶切除术患者围手术期的体温,保持内环境和凝血功能的稳定,优化术中体温管理,值得推广。ObjectiveTo investigate the effects of heating combined with target-directed fluid therapy(GDFT)on perioperative body temperature,homeostasis and coagulation function in patients with hepatic echinococcosis.Methods64 patients with hepatic echinococcosis who underwent liver lobectomy admitted to the hospital from August to December 2021 were selected as research objects and divided into conventional group and combined group by random number table method,with 32 cases in each group.In the conventional group,conventional fluid management was adopted,thermal insulation blanket was used to keep warm,and the peritoneal washing solution was heated to 37℃.The combined group was treated with target-directed fluid on the basis of the conventional group.Meanwhile,transfusion and blood were warmed to 37℃by a temperature apparatus.The differences of nasopharyngeal temperature,homeostasis and coagulation function indexes 1 day before and 1 day after the surgery were compared between the two groups.ResultsThe nasopharyngeal temperature of the combined group remained at normal level during perioperative period and no intraoperative hypothermia occurred.Intraoperative arterial pH(pH)and alkali surplus(BE)were significantly higher than those in conventional group(P<0.05),and blood glucose(GLU)was significantly lower than those in conventional group(P<0.05).Plasma prothrombin time(PT),activated partial thrombin time(APTT)and prothrombin time(TT)were shorter than those in conventional group,while fibrinogen(FIB)level was lower than that in conventional group(P<0.05).ConclusionOn the basis of target-oriented fluid therapy,the heating of intraoperative infusion,blood transfusion and rinse solution can effectively maintain perioperative body temperature of the patients undergoing hepatic hydatid lobectomy,maintain the stability of internal environment and coagulation function,and optimize intraoperative body temperature management,which is worthy of promotion.

关 键 词：目标导向性液体治疗 肝包虫 肝叶切除术 围手术期 液体加温 

分 类 号：R472.3[医药卫生—护理学]