ERAS理念下的多模式保温联合多感官促醒刺激对老年髋部骨折全麻手术患者的影响  

Effects of multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept on elderly patients undergoing general anesthesia for hip fracture

作　　者：施春娟 钟宝英[1] 鲍映雪 SHI Chunjuan;ZHONG Baoying;BAO Yingxue(Operation Room of Tongde Hospital of Zhejiang Province,Hangzhou,Zhejiang 310012,China;不详)

机构地区：[1]浙江省立同德医院手术室,浙江杭州310012 [2]浙江省人民医院手术室,浙江杭州314408

出　　处：《中华全科医学》2024年第9期1601-1604,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技项目(2022KY496)。

摘　　要：目的基于ERAS理念构建多模式保温联合多感官促醒刺激方案,探讨其对老年髋部骨折全麻手术患者的影响,旨在为优化围手术期护理提供理论参考。方法选取2019年9月—2023年9月在浙江省立同德医院择期进行老年髋部骨折全麻手术患者102例,采用随机数字表法分为2组,对照组51例,采取传统保温措施和语言唤醒方案;观察组51例,采取以ERAS理念为指导的多模式保温联合多感官促醒刺激方案,比较2组体温、应激情况、麻醉苏醒质量以及不良反应发生率。结果观察组麻醉诱导后(T1)、手术开始时(T2)、手术40 min(T3)、手术结束时(T4)体温均高于对照组(P<0.05)。T1~T4时刻的皮质醇(Cor)、去甲肾上腺素(NE)水平均低于对照组(P<0.05)。自主呼吸恢复时间[(5.21±1.09)min vs.(7.09±1.32)min]、意识恢复时间[(16.23±3.12)min vs.(25.90±4.77)min]以及麻醉恢复室滞留时间[(33.22±5.67)min vs.(50.09±8.23)min]均短于对照组(P<0.05)。总不良反应发生率(9.80%vs.29.41%)低于对照组(χ^(2)=6.220,P=0.013)。结论ERAS理念下的多模式保温联合多感官促醒刺激可维持老年髋部骨折全麻手术患者术中体温稳定,缓解应激反应,提高麻醉苏醒质量,降低不良反应发生率。ObjectiveBased on the ERAS concept,a multi-mode thermal insulation combined with multi-sensory awakening stimulation program was constructed to explore its influence on elderly patients undergoing general anesthesia for hip fracture,aiming to provide theoretical reference for optimizing perioperative nursing.MethodsA total of 102 elderly patients undergoing general anesthesia for hip fracture at Tongde Hospital of Zhejiang Province from September 2019 to September 2023 were selected and divided into two groups by random number table method.The control group(n=51)were given traditional heat preservation measures and language awakening program,while the observation group(n=51)was treated with a multi-mode thermal insulation combined with multi-sensory awakening stimulation program guided by ERAS concept.Differences in body temperature,stress levels,quality of anesthesia recovery,and incidence of adverse reactions were compared between the two groups.ResultsThe body temperature of the observation group was higher than that in the control group after anesthesia induction(T1),the beginning of surgery(T2),40 min after surgery(T3),and at the end of surgery(T4,P<0.05).Levels of cortisol(Cor)and norepinephrine(NE)at T1-T4 were lower in the observation group than those in the control group(P<0.05).Recovery times of spontaneous respiration [(5.21±1.09)min vs.(7.09±1.32)min],consciousness[(16.23±3.12)min vs.(25.90±4.77)min],and retention in the anesthesia recovery room[(33.22±5.67)min vs.(50.09±8.23)min]were shorter than those in the control group(P<0.05).The incidence of adverse reactions in the observation(9.80%vs.29.41%)was lower than that in the control group(χ^(2)=6.220,P=0.013).ConclusionThe multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept can maintain the stability of body temperature during operation,relieve stress response,improve the quality of anesthesia recovery,and reduce the incidence of adverse reactions in elderly patients undergoing general anesthesia

关 键 词：髋部骨折 全身麻醉 体温管理 多感官促醒 应激反应 躁动 

分 类 号：R473.6[医药卫生—护理学] R614.2[医药卫生—临床医学]