手术室强化保温策略在颈脊髓损伤患者中的应用效果  

Application effects of enhanced heat preservation strategies in the operation room for patients with cervical spinal cord injuries

作　　者：古茹 赵丽燕[1] 李棪臻 李娜[1] 范凯利 王嘉龙 王倩茹[1] 王红[2] 王苗 李水霞 Gu Ru;Zhao Liyan;Li Yanzhen;Li Na;Fan Kaili;Wang Jialong;Wang Qianru;Wang Hong;Wang Miao;Li Shuixia(Department of Anesthesiology,Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China;First Department of Anesthesiology,Affiliated Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学第二附属医院麻醉手术科,西安710004 [2]西安交通大学附属红会医院手术麻醉一科,西安710054

出　　处：《中华创伤杂志》2024年第11期1022-1027,共6页Chinese Journal of Trauma

摘　　要：目的比较手术室强化保温策略与常规保温对颈脊髓损伤患者术后体温、凝血功能和心肌损伤的影响。方法采用回顾性队列研究分析2022年2月至2022年10月西安交通大学第二附属医院和西安交通大学附属红会医院收治的160例颈脊髓损伤患者的临床资料,其中男82例,女78例;年龄38~64岁[(50.6±8.7)岁]。损伤节段:C_(3)19例,C_(4)33例,C_(5)39例,C_(6)38例,C_(7)31例。美国脊髓损伤协会(ASIA)分级:A级10例,B级83例,C级39例,D级28例。均采用颈椎管扩大减压植骨融合术。根据术中保温方式不同,将患者分为常规保温组(80例)和强化保温组(80例)。比较两组术前、术中2 h、术后即刻、术后2 h及术后24 h体温变化;术前、术后4 h凝血功能变化,包括凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT);术后48 h心肌损伤发生率和以心肌肌钙蛋白I(cTnI)和高敏感性肌钙蛋白T(hs-cTnT)作为指标衡量心肌损伤发生例数。术前、术后14 d采用ASIA分级评估两组神经功能,包括感觉功能和运动功能。统计术后12个月两组心血管事件发生率。结果145例患者获随访12~18个月[(15.7±1.6)个月]。术后12个月,强化保温组失访7例,常规保温组失访8例。术前及术后24 h,两组体温差异均无统计学意义(P>0.05)。术中2 h、术后即刻及术后2 h,强化保温组体温分别为(36.90±0.12)℃、(37.00±0.06)℃、(37.16±0.06)℃,均明显高于常规保温组的(36.56±0.03)℃、(36.74±0.08)℃、(36.84±0.08)℃(P<0.01)。术前两组血清PT、TT、APTT差异均无统计学意义(P>0.05);术后4 h,强化保温组PT、TT、APTT分别为(13.1±1.2)s、(19.2±1.1)s、(36.2±3.3)s,均明显低于常规保温组的(14.3±1.0)s、(20.2±1.1)s、(38.7±3.4)s(P<0.01)。术后48 h,强化保温组心肌损伤发生率为5.0%(4/80),低于常规保温组的12.5%(12/80)(P<0.05)。以cTnI作为衡量心肌损伤的指标,强化保温组2例[2.6%(2/76)]发生心肌损伤,远低�Objective To compare the effects of enhanced heat preservation strategies and conventional heat preservation strategies in the operation room on body temperature,coagulation function,and myocardial injury in patients with cervical spinal cord injuries.Methods A retrospective cohort study was conducted to analyze the clinical data of 160 patients with cervical spinal cord injuries admitted to Second Affiliated Hospital of Xi′an Jiaotong University and Affiliated Honghui Hospital of Xi′an Jiaotong University from February to October 2022,including 82 males and 78 females,aged 38⁃64 years[(50.6±8.7)years].Injured segments included C_(3) in 19 patients,C_(4) in 33,C_(5) in 39,C_(6) in 38,and C_(7) in 31.According to American Spinal Injury Association(ASIA)classification,10 patients were classified into grade A,83 grade B,39 grade C,and 28 grade D.All the patients underwent cervical laminoplasty,decompression and bone graft fusion surgery.According to different heat preservation strategies intraoperatively,the patients were divided into conventional heat preservation group(n=80)and enhanced heat preservation group(n=80).The body temperature changes before surgery,at 2 hours during surgery,immediately after surgery,at 2 and 24 hours after surgery were compared between the two groups.The changes of coagulation function before surgery and at 4 hours after surgery were compared between the two groups,including the prothrombin time(PT),thrombin time(TT),and activated partial thromboplastin time(APTT).The incidence of myocardial injury and the number of patients with myocardial injury measured by the indicators of cardiac troponin I(cTnI)and high⁃sensitivity cardiac troponin T(hs⁃cTnT)at 48 hours after surgery.Before surgery and at 14 days after surgery,ASIA classification was used to evaluate the neurological functions,including sensory and motor functions between the two groups.The incidence of cardiovascular events at 12 months after surgery were compared between the two groups.Results A total of 145 patients

关 键 词：脊髓损伤 心肌 体温 凝血功能 

分 类 号：R473.6[医药卫生—护理学]