全程保温护理管理对全身麻醉腹腔镜手术患者免疫应激反应及苏醒质量的影响  

Impacts of whole-course insulation nursing management on immune stress response and awakening quality of patients undergoing laparoscopic surgery under general anesthesia

作　　者：阴慧华 陈小敏 何莉 YIN Huihua;CHEN Xiaomin;HE Li(Operation Room,Sanming Hospital of Integrated Traditional Chinese and Western Medicine,Sanming 365001,China;Department of Emergency,Sanming Hospital of Integrated Traditional Chinese and Western Medicine,Fujian Province,365001;ICU,the First Hospital of Sanming,Sanming 365000,China)

机构地区：[1]福建省三明市中西医结合医院手术室,福建三明365001 [2]福建省三明市中西医结合医院急诊科,福建三明365001 [3]福建省三明市第一医院ICU,福建三明365000

出　　处：《中国医药科学》2023年第10期133-137,共5页China Medicine And Pharmacy

摘　　要：目的 探讨全程保温护理管理对全身麻醉腹腔镜手术患者免疫应激反应及苏醒质量的影响。方法回顾性分析2020年1月至2022年1月在三明市中西医结合医院接受全身麻醉腹腔镜手术的患者96例,按护理方法不同分为对照组和观察组,每组各48例,对照组患者实施常规护理干预,观察组患者实施全程保温护理管理,测定体温变化情况,麻醉前、术毕进行免疫指标、应激反应指标检测,术毕及麻醉清醒后进行血氧饱和度监测及Steward苏醒评分评判,比较两组麻醉苏醒情况,统计并发症发生率。结果 观察组手术开始60 min、术毕体温明显高于对照组,差异有统计学意义(P <0.05)。观察组术毕去甲肾上腺素(NE)、皮质醇(Cor)明显高于治疗前,但明显低于对照组,差异有统计学意义(P <0.05)。观察组术后24 h肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)明显高于治疗前,但明显低于对照组,免疫球蛋白(IgA、IgG)、T淋巴细胞亚群(CD3^(+)、CD4^(+))明显低于治疗前,但明显高于对照组,差异有统计学意义(P <0.05)。观察组麻醉清醒后意识评分和血氧饱和度明显高于术毕及对照组麻醉清醒后,差异有统计学意义(P <0.05)。观察组拔管时间、完全清醒时间、麻醉复苏室滞留时间明显短于对照组,差异有统计学意义(P <0.05)。观察组术中并发症发生率明显低于对照组,差异有统计学意义(P <0.05)。结论 全程保温护理管理在全身麻醉腹腔镜手术中应用能够稳定体温,减轻手术应激反应及炎症反应,提高免疫功能,进而降低并发症发生率,促进术后苏醒,并提高苏醒质量。Objective To investigate the impacts of whole-course insulation nursing management on immune stress response and awakening quality of patients undergoing laparoscopic surgery under general anesthesia.Methods The clinical data of 96 cases of patients undergoing laparoscopic surgery under general anesthesia in Sanming Integrated Medicine Hospital from January 2020 to January 2022 were retrospectively analyzed.According to different nursing methods,the patients were divided into the control group(n=48)and the observation group(n=48).Patients in the control group were treated with conventional nursing intervention,while those in the observation group were treated with whole-course insulation nursing management.The changes of body temperature were detected.Before anesthesia and after operation,the immune indices and stress response indices were detected.After operation and after awakening from anesthesia,the blood oxygen saturation monitoring and the Steward awakening score evaluation were performed.The awakening from anesthesia and the incidence of complications between the two groups were compared.Results In the 60 minutes of operation and after operation,body temperature of the observation group was remarkably higher than that of the control group,with statistically significant difference(P<0.05).After operation,the levels of norepinephrine(NE)and cortisol(Cor)in the observation group were remarkably higher than those before treatment,but obviously lower than those in the control group,with statistically significant differences(P<0.05).In the 24th hour after operation,the tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the observation group were remarkably higher than those before treatment,but obviously lower than those in the control group;Immunoglobulin(IgA,IgG)and T lymphocyte subsets(CD3^(+),CD4^(+))were remarkably lower than those before treatment,but obviously higher than those in the control group,with statistically significant differences(P<0.05).The consciousness score after awakening from a

关 键 词：全身麻醉腹腔镜手术 全程保温护理 免疫功能 应激反应 苏醒质量 

分 类 号：R614.2[医药卫生—麻醉学]