不同保温措施对经尿道前列腺电切术患者寒战的影响研究

发布时间：2018-01-01 01:28

  本文关键词：不同保温措施对经尿道前列腺电切术患者寒战的影响研究　出处：《南华大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 前列腺电切 寒战 低温 冲洗液 充气式加温系统

【摘要】：目的:为探讨最佳的物理保温措施,我们对TURP患者分别采取了冲洗液加温、充气式温毯机加温、冲洗液和温毯机联合加温3种保温方案。观察并比较3组患者的体温和寒战发生情况,同步监测生命体征的变化,记录寒战、呕吐、肌肉酸痛等不良反应的发生率,评价心肌的氧耗状况。方法:选择90例于腰硬联合麻醉(CSEA)下择期行TURP的患者,ASAⅠ~Ⅱ级,年龄50~70岁。采用随机数字表法随机地分为3组:A组(冲洗液加温组)、B组(充气式温毯机加温组)、C组(冲洗液和温毯机联合加温组)。A组将等渗冲洗液放置于可调控恒温水箱中保温,设定温度为35℃~37℃,患者上半身覆盖手术室常用的普通棉被;B组患者上半身覆盖充气式升温毯,冲洗液为术前60 min摆放于手术室内的等渗冲洗液;C组冲洗液为预置于35℃~37℃恒温水箱的等渗冲洗液,同时上半身覆盖充气式升温毯。术中记录各组患者在病房(T1)、进手术室(T2)、CSEA后5 min(T3)、CSEA后10 min(T4)、持续冲洗10 min(T5)、持续冲洗30 min(T6)、持续冲洗60 min(T7)、持续冲洗90 min(T8)、停止冲洗(T9)、手术结束(T10)各时间点的腋温和鼻咽温情况;观察各组寒战发生率,并评估寒战严重程度;记录各组呕吐、肌肉酸痛等不良反应的发生率;同步监测各时间点HR、MAP、SPO2和心肌耗氧量的变化情况。结果:1.三种保温措施对TURP患者体温、寒战发生情况的影响:各组鼻咽温的比较差异均具有统计学意义(P0.05)。A组的鼻咽温在各时间点与C组相比均具有统计学差异(P0.05),而在某些时间点与B组比较无统计学差异(P0.05);寒战发生率,A组最高,与B组和C组比较均具有统计学差异(P0.05);寒战分级,A组严重程度均高于其他两组,差异具有统计学意义(P0.05)。2.三种保温措施对主要生命体征的影响:在麻醉前及麻醉后到离开手术室,HR、MAP与SPO2的波动幅度,C组均小于A组和B组,差异具有统计学意义(P0.05)。3.三种保温措施对呕吐、肌肉酸痛等不良反应发生的影响:呕吐发生情况,3组比较差异具有统计学意义(P0.05),B组和C组比较无统计学差异(P0.05);肌肉酸痛发生情况,A组与B组比较无统计学差异(P0.05),A组、B组肌肉酸痛人数均多于C组,与C组比较,差异具有统计学意义(P0.05)。4.三种保温措施对心肌耗氧量的影响:与术前比较,各组心肌耗氧量均升高(P0.05);其中,A组与B组比较,A组升高明显(P0.05);C组与B组比较,B组升高明显(P0.05)。结论:冲洗液加温与充气式温毯机加温相比,预防低体温与寒战的效果无明显差异;联合应用冲洗液加温与充气式温毯机加温对于降低TURP患者术中寒战与低体温的发生、减轻患者的不适、降低心肌耗氧量等方面具有良好的效果,值得在临床上推广。
[Abstract]:Objective: in order to explore the best physical insulation measures, we took the washing solution heating and the inflatable blanket machine to the patients with TURP. The temperature and shivering of the three groups were observed and compared, the changes of vital signs were monitored synchronously, shivering and vomiting were recorded. Incidence of adverse reactions such as muscle soreness, and evaluation of myocardial oxygen consumption. Methods: 90 patients undergoing selective TURP under combined spinal-epidural anesthesia were enrolled in this study. The age was 50 to 70 years old. The patients were randomly divided into three groups: group A (group B), group B (group B), and group B (group B). Group C (washing fluid and warm blanket machine combined with heating group). Group A placed isosmotic flushing fluid in adjustable and constant temperature water tank for heat preservation, setting temperature of 35 鈩，

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