多维度精细化体温管理策略在非体外循环下冠状动脉搭桥手术中的应用效果  

Application of multi-dimensional refined temperature management strategy in off-pump coronary artery bypass grafting

作　　者：靖茹 韩小红[1] JING Ru;HAN Xiaohong(Cardiothoracic Vascular Operating Room,Nanjing First Hospital,Nanjing Medical University,Nanjing,Jiangsu 210001,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心胸血管手术室,江苏南京210001

出　　处：《医药前沿》2025年第9期117-120,共4页Journal of Frontiers of Medicine

摘　　要：目的探讨多维度精细化体温管理策略在非体外循环下冠状动脉搭桥手术中的应用效果,观察其对患者核心体温的影响。方法选取2023年3月—2024年5月在南京医科大学附属南京医院行非体外循环下冠状动脉搭桥手术的患者120例,根据术中不同的保温措施分为常规保温组(n=62)和复合保温组(n=58)。常规保温组采用常规保温措施,复合保温组采用多维度精细化体温管理策略。比较两组入室时(T_(1))、麻醉后30 min(T_(2)),手术1h后(T_(3)),手术2 h后(T_(4)),手术结束时(T_5),转入ICU时(T_(6))的核心体温;比较两组麻醉复苏时间、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fbg)、凝血酶时间(TT);记录两组术中低体温及获得性压力性损伤的发生情况。结果复合保温组T_(2)~T_(6)时核心温度高于常规保温组,差异有统计学意义(P<0.05)。术后,复合保温组PT、TT、APTT短于常规保温组,差异有统计学意义(P<0.05)。两组麻醉复苏时间比较,差异无统计学意义(P>0.05);复合保温组低体温及术中获得性压力性损伤发生率低于常规保温组,差异有统计学意义(P<0.05)。结论非体外循环下冠状动脉搭桥手术患者采用多维度精细化体温管理策略可有效维持其核心体温,降低并发症发生率,提高护理质量。Objective To investigate the effect of multi-dimensional refined temperature management strategy on core body temperature of patients undergoing off-pump coronary artery bypass grafting.Methods A total of 120 patients who underwent off-pump coronary artery bypass grafting in Nanjing First Hospital,Nanjing Medical University from March 2023 to May 2024 were selected,and they were divided into conventional thermal insulation group(62 cases)and composite thermal insulation group(58 cases)according to different thermal insulation measures during the operation.The core body temperature of two groups were compared at the time of entry(T_(1)),30 min after anesthesia(T_(2)),1 h after surgery(T_(3)),2 h after surgery(T_(4)),at the end of surgery(T_(5)),and when transferred to ICU(T6);anesthesia recovery time,activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fbg),and thrombin time(TT)were compared between two groups;and intraoperative hypothermia,and acquired stress injury were recorded between two groups.Results The core temperature at T_(2)-T6 in composite thermal insulation group was higher than that in conventional thermal insulation group,and the difference was statistically significant(P<0.05).After surgery,PT,TT,and APTT in composite thermal insulation group were shorter than those in conventional thermal insulation group,and the differences were statistically significant(P<0.05).There was no significant difference in anesthesia recovery time between two groups(P>0.05).The incidence of hypothermia and intraoperative stress injury in composite thermal insulation group was lower than that in conventional thermal insulation group,and the difference was statistically significant(P<0.05).Conclusions The multidimensional refined body temperature management strategy can effectively maintain the core body temperature,reduce the incidence of complications and improve the quality of nursing in patients with off-pump coronary artery bypass grafting.

关 键 词：体温管理策略 冠状动脉搭桥术 核心体温 获得性压力性损伤 非体外循环 

分 类 号：R473[医药卫生—护理学]