不同新鲜气体流量麻醉对腹腔镜肾脏手术患者术中体温的影响

发布时间：2018-06-12 04:04

本文选题：低体温 + 低流量麻醉　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景及目的术中意外低体温(hypothermia)是围手术期间常见并发症之一,可引发一系列不良后果,不利于患者术后的康复。因此,在围手术期间防治低体温并发症十分必要。除减少环境污染、获取经济效益外,低流量麻醉(low flow anesthesia,LFA)已证实可改善麻醉呼吸回路中吸入气体的温度和湿度。在临床实践中,吸入麻醉药物七氟醚被广泛运用于LFA技术。本研究采用前瞻性、随机、对照的研究方法,观察不同新鲜气体流量(Fresh gas flow,FGF)对泌尿外科腹腔镜肾脏手术患者术中体温的影响。资料与方法选取择期行腹腔镜肾脏手术的患者60例,ASA分级I-II,随机分成三组,每组各20例。H组:麻醉维持阶段FGF为2 L · min-1。M组:麻醉维持阶段FGF为1 L · min-1。L组:麻醉维持阶段FGF为0.75L · min-1。室内温度维持在22℃C-23℃C,相对湿度40%-60%。每组患者术中非手术区域皮肤均覆盖相同材质的无菌单,术中输入未加温液体。采用静脉吸入复合全麻,麻醉诱导给予咪达唑仑(midazolam)0.05mg · kg-1,舒芬太尼(sufentanil)0.2 ug · kg-1、依托咪酯(tomidate)0.2mg · kg-1 和罗库溴铵(rocuronium)0.6mg · kg-1。七氟醚持续吸入、顺式阿曲库胺(cisatracurium)间断给予维持麻醉。喉罩(LMASupreme)置入后,置入鼻咽温度探测元件评估核心温度,监测前臂-指尖体表温度差评估指尖血流灌注。于麻醉诱导后即刻(T1)开始,每隔15分钟记录一次呼气末二氧化碳分压(ETC02)、呼气末七氟醚浓度(ETSC)、血氧饱和度(Sp02)、鼻咽温度(Tc)、前臂温度(Ta)、指尖温度(Tf)、心率(HR)和平均动脉压(MAP),至停七氟醚时刻(T10)。Ta减去Tf即为前臂-指尖体表温度差(Ta-f)。研究结果1.一般资料三组患者分别在性别、年龄、身高、体重指数、手术时间、麻醉时间、术中液体输注量、术中尿量、术中失血量等方面无统计学差异(p0.05)。2.心率变化手术麻醉过程中,三组患者的HR降趋势,后缓慢升高。但三组间HR变化无显著差异(p0.05)。与基础HR相比,三组患者HR变化无明显统计学差异(p0.05)。3.平均动脉压变化三组患者的MAP变化无明显统计学差异(p0.05)。与基础MAP相比,三组患者MAP变化无明显统计学差异(p0.05)。4.核心温度变化静脉麻醉诱导后,三组患者Tc均呈下降趋势:先显著下降,后下降趋势逐渐变缓。H组Tc在T10(停七氟醚时刻)下降0.94℃,降至36℃以下;M组Tc下降0.59℃,L组Tc降低0.44℃,但两组均在36℃以上。在T1、T2和T3时间监测点,三组间Tc变化无显著差异(p0.05)。H组Tc从T4时刻(诱导后45min)开始低于L组患者(p0.05);M组Tc从T5时刻开始低于M组患者(p0.05);M组Tc从T7时刻开始低于L组患者(p0.05)。与T1(麻醉诱导后即刻)相比,三组患者Tc均于T4时刻起变化有明显统计学差异(p0.05)。5.前臂-指尖体表温度差变化三组患者的Ta-f均逐渐升高。H组Ta-f于T9时刻、M组Ta-f于T8时刻、L组Ta-f于T7时刻由负值转为正值。但三组间Ta-f变化差异无统计学意义(p0.05)。H组从T7时间点开始记录的Ta-f值与T1值相比均有显著差异(p0.05);M组和L组在T6时间点开始记录的Ta-f值与T1值相比均有显著差异(p0.05)。研究结论:0.75 L · min-1和1 L · min-1的FGF与2 L · min-1的FGF相比均可有效预防腹腔镜患肾脏手术患者术中低体温并发症的发生。而与1 L · min-1的FGF的相比较,0.75 L · min-1的FGF麻醉对患者体温的保护作用更显著。
[Abstract]:Background and objective intraoperative hypothermia (hypothermia) is one of the common complications during perioperative period, which can lead to a series of adverse consequences and is not conducive to postoperative rehabilitation. Therefore, it is necessary to prevent hypothermia complications during perioperative period. In addition to reducing environmental pollution and obtaining economic benefits, low flow anaesthesia (low flow anesthesia) LFA) has proved to improve the temperature and humidity of the inhaled gas in the anesthetic respiratory circuit. In clinical practice, the inhaled anesthetic sevoflurane is widely used in LFA technology. This study uses a prospective, randomized, controlled study to observe the different fresh gas flow (Fresh gas flow, FGF) for laparoscopic renal surgery in the Department of urology. Data and methods 60 cases of laparoscopic renal surgery were selected and divided into three groups, 20 cases of.H group in each group: FGF of 2 L. Min-1.M at the maintenance stage of anesthesia: FGF of 1 L. Min-1.L at the maintenance stage of anesthesia: FGF to 0.75L in the maintenance phase of anesthesia at 22 degrees centigrade. A sterile sheet of the same material was covered with the same material in the non operative area of each group of patients with humidity 40%-60%.. Inputting the unheated liquid during the operation. Intravenous inhalation combined general anesthesia was used to induce midazolam (midazolam) 0.05mg. Kg-1, sufentanil (sufentanil) 0.2 UG kg-1, etomidate (tomidate) 0.2mg kg-1 and rocuronium (ROC). Uronium) 0.6mg. Kg-1. sevoflurane continuous inhalation, CIS atracuramide (cisatracurium) intermittently for maintenance anesthesia. After insertion of the laryngeal mask (LMASupreme), the core temperature of the nasopharynx temperature detection element is assessed and the forearm fingertip surface temperature difference is monitored to assess the fingertip blood flow. Immediately after the induction of anesthesia (T1), every 15 minutes is recorded. The end expiratory carbon dioxide partial pressure (ETC02), the end expiratory sevoflurane concentration (ETSC), the blood oxygen saturation (Sp02), the nasopharyngeal temperature (Tc), the forearm temperature (Ta), the fingertip temperature (Tf), the heart rate (HR) and the mean arterial pressure (MAP), to the time of stopping sevoflurane (T10).Ta minus Tf are the temperature difference between the forearm fingertip body surface (Ta-f). The results of the 1. general data of three groups of patients were respectively in Sex, age, height, body mass index, operation time, anesthesia time, intraoperative fluid infusion, intraoperative urine volume, and intraoperative blood loss were not statistically different (P0.05).2. heart rate change operation anesthesia process, the three groups of patients with HR trend, and then slow increase. But there was no significant difference in HR between the three groups (P0.05). Compared with basic HR, three groups of patients HR There was no significant difference in statistical difference (P0.05).3. mean arterial pressure changes in three groups of patients with no significant statistical difference (P0.05). Compared with the basic MAP, there was no significant difference between the three groups of patients (P0.05).4. core temperature changes induced by intravenous anesthesia, the three groups of patients showed a downward trend: the first significant decrease, then descending trend. The gradual decrease of.H group Tc dropped 0.94 degrees centigrade at T10 (stopped sevoflurane moment) and below 36 C, Tc decreased by 0.59, and L group Tc decreased 0.44 degrees C, but the two groups were above 36 centigrade. There was no significant difference between the three groups at T1, T2 and T3 time monitoring points in the two groups. In group M (P0.05), Tc in group M was lower than that in group L (P0.05). Compared with T1 (immediately after induction of anesthesia), there was a significant difference between the three groups of Tc at T4 time (P0.05). The difference in Ta-f changes between the three groups was not statistically significant (P0.05) the Ta-f value of the.H Group recorded from the T7 time point was significantly different from the T1 value (P0.05). The Ta-f values of M and L groups at T6 time points were significantly different from those of the T1 values. L / min-1's FGF can effectively prevent the occurrence of hypothermia complications during laparoscopic renal surgery. Compared with FGF of 1 L. Min-1, 0.75 L. Min-1's FGF anesthesia is more protective for the patient's body temperature.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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