腹腔热灌注化疗患者术中实施不同目标体温管理的效果观察  

Effect of target temperature management strategy on intraoperative temperature management in patients undergoing hyperthermic intraperitoneal chemotherapy

作　　者：刘璐[1] 朱钰 曹义 张华[1] 彭玉娜[1] LIU Lu;ZHU Yu;CAO Yi;ZHANG Hua;PENG Yu-na(Operation Center,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院手术中心,天津300192

出　　处：《护理学报》2025年第4期59-63,共5页Journal of Nursing(China)

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-045A)。

摘　　要：目的 观察基于不同目标温度的体温管理策略在腹腔热灌注化疗患者术中体温管理中的应用效果。方法 选取2022年1月—2023年12月在天津市某三级甲等综合医院手术中心接受腹腔热灌注化疗的120例结直肠恶性肿瘤患者,按照时间顺序随机分为对照组和观察组各60例。对照组患者采用传统体温管理方案,观察组患者采用基于不同目标温度的体温管理方案。观察2组患者在腹腔热灌注化疗开始前(T1)、灌注15 min(T2)、灌注30 min(T3)、灌注45 min(T4)和结束灌注即刻(T5)膀胱温和食道温的变化情况,比较2组患者中-重度高热、血压降低、代谢性酸中毒、心律失常和术后寒战等围手术期并发症的发生率,并于治疗后3个月回访患者,观察术后生存和肿瘤复发情况的差异。结果 热灌注开始后,在T3~T5时,观察组患者的食道温较对照组均显著降低,差异有统计学意义(P<0.05)。与对照组相比,观察组患者中-重度高热、血压降低、代谢性酸中毒、心律失常和术后寒战的发生率均显著降低,差异有统计学意义(P<0.05)。结论 腹腔热灌注化疗患者术中接受基于不同目标温度的体温管理可有效预防核心温度过度升高,降低围手术期高热和相关并发症的发生率。Objective To observe the effect of temperature management strategy based on different target temperatures on intraoperative temperature management in patients undergoing hyperthermic intraperitoneal chemotherapy(HIPEC).Methods A total of 120 patients with colorectal cancer who underwent HIPEC in the operation center of a tertiary grade-A general hospital in Tianjin from January 2022 to December 2023 were selected and randomly divided into control group(n=60)and observation group(n=60)according to chronological order.Patients in the control group were treated with traditional temperature management,ad those in the observation group with temperature management strategy based on different target temperatures.Bladder and esophageal temperatures before HIPEC(T1),15 min after the beginning(T2),30 min after the beginning(T3),45 min after the beginning(T4)and at the end of HIPEC(T5)were observed in the two groups,and the incidence of perioperative adverse events such as moderate to severe hyperthermia,reduction of blood pressure,metabolic acidosis,arrhythmia and postoperative shivering was compared between the two groups.The patients were followed up 3 months after the treatment to observe the differences in postoperative survival and tumor recurrence.Results During HIPEC,esophageal temperature in the observation group was significantly lower than that in the control group at T3-T5,showing statistical significance(P<0.05).Compared with that in the control group,the incidence of moderate to severe hyperthermia,reduction of blood pressure,metabolic acidosis,arrhythmia and postoperative shivering in observation group was significantly lower(P<0.05),showing statistical significance.Conclusion Intraoperative temperature management strategy based on different target temperatures in patients undergoing HIPEC can effectively prevent excessive increase of core temperature and reduce the incidence of perioperative high fever and related complications.

关 键 词：结直肠肿瘤 腹膜转移 腹腔热灌注化疗 体温管理 围手术期护理 

分 类 号：R473.6[医药卫生—护理学]