充气式保温毯预防胃癌根治术病人围术期低体温的临床观察
发布时间：2018-07-15 12:04
【摘要】：目的： 体温是指机体内部的温度,是人体重要的生命体征之一,人体的温度是相对恒定的,恒定的体温使机体各器官系统的机能活动持续稳定地保持在较高的水平上,增强了机体适应环境的能力。机体在体温调节机制的调控下,使产热过程和散热过程处于平衡,即体热平衡,维持正常的体温。如果机体的产热量大于散热量,体温就会升高；散热量大于产热量则体温就会下降,直到产热量与散热量重新取得平衡时,才会使体温稳定在新的水平。然而低体温却成为危害病人麻醉手术安全的重要因素之一。导致病人出现围术期低体温的因素有很多：如病人自身因素,麻醉药物的影响,环境因素,手术种类,输血、输液以及大量冲洗液的使用等。围术期低体温会给病人带来许多危害：如麻醉苏醒时间增长,术中出血量增多,手术部位感染发生率增加,酸碱平衡失调,呼吸、循环、神经系统并发症增多,术后寒颤、发热发生率增加,甚至危及病人生命。如何加强术中体温监测,预防低体温的发生,成为临床麻醉研究的热点。充气式保温毯依靠温暖气流在病人肌肤间形成特有的暖流层,使病人始终处于温暖环境中,有效地阻止了机体总热量的散失。本文拟观察胃癌根治术病人围术期采用充气式保温毯预防低体温的临床效果。 方法： 收集2013年9月至2014年2月期间山东大学附属省立医院胃肠外科行胃癌根治术病人100例,ASA Ⅰ～Ⅱ级,男64例,女36例,年龄45-72岁,体重指数20-25,手术时间均在3小时以上。随机分为保温组和对照组,每组50例。将室温调节至26°C,所有输液和冲洗液保持室温。病人进入手术室后(TO),测量鼻咽温,于鼻咽表麻后置入鼻咽温监测探头,鼻咽温探头自鼻腔插入约10-12cm。并监测心电图(ECG)、心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2),建立静脉通路,静注盐酸戊乙奎醚0.01mg·kg-1。保温组病人入室后用充气式保温毯覆盖下半身,范围为双侧髂前上棘连线以下,调节充气温度为40°C,而对照组病人常规处理。 两组病人采用相同的麻醉方法。静脉注射咪达唑仑0.04mg·kg-1,顺阿曲库铵0.2mg·kg-1,依托咪酯0.2mg·kg-1,舒芬太尼0.5μg·kg-1。面罩通气3分钟后气管插管,行机械通气。调整呼吸机参数：呼吸频率10-12次·mmin-1,潮气量8-10mg·kg-1,吸呼比1：2,氧流量2.0L·min-1,根据二氧化碳分压(维持在35～45mmHg之间)调节潮气量和呼吸频率。两组病人术中均以恒定速度泵入丙泊酚8～12mg·kg-1·h-1,在手术结束前10分钟时,停止丙泊酚的泵入。间断静脉注射顺阿曲库铵0.1mg·kg-1,当手术结束前半小时时,停止注射顺阿曲库铵。手术过程中必要时追加舒芬太尼0.1μg·kg-1。当病人出现吞咽或呛咳后,给予新斯的明lmg。术中如果需要输血,将血液置于恒温箱15分钟后,再输入病人体内。 记录采集病人入室后(TO)以及麻醉诱导后30min (T1)、60min (T2)、90min (T3)、120min(T4)、150min(T5)、180min(T6)和手术结束(T7)时的心率(HR)、平均动脉压(MAP)、鼻咽温度变化。观察记录病人术中出血量。记录病人苏醒时间及有无寒颤,其中苏醒时间为从手术结束至病人Steward苏醒评分达到4分所用的时间。术后观察记录病人有无发热及术后住院天数,其中发热指标为体温在37.4°C以上。所有数据均使用SPSS19.0软件统计分析,计量数据采用x±s表示,组内比较采用重复测量数据的单因素方差分析,组间比较采用两样本t检验,计数资料的比较采用x2检验,P0.05为差异具有统计学意义。 结果： 入室后(TO)测量鼻咽温,两组病人无统计学差异(P0.05)。组内比较,麻醉诱导后30min (T1)体温与入室后(TO)体温相比,两组病人均明显降低(p0.05),对照组病人手术结束时(T7)体温较入室后(TO)体温显著降低(p0.05),保温组病人体温虽也呈下降趋势,但与对照组相比,下降趋势较为缓慢。组间比较,对照组与保温组于麻醉诱导后120min (T4)、150min (T5)、180min(T6)及手术结束时(T7),体温差异显著(P0.05),保温组体温明显高于对照组。两组病人麻醉期间平均动脉压(MAP)、心率(HR)差异无显著意义。保温组病人与对照组病人相比,术中出血量及术后寒颤的发生率明显减少(P0.05)。保温组病人的苏醒时间明显缩短(P0.05),术后3天内发热人数普遍减少,住院天数也相应缩短。 结论： 胃癌根治术病人围术期采用充气式保温毯,可有效预防低体温的发生,缩短麻醉苏醒时间,减少术中出血量,降低术后寒颤、发热发生率,缩短住院时间。
[Abstract]:Objective:
Temperature refers to the temperature inside the body. It is one of the vital signs of human life. The temperature of the body is relatively constant. The constant body temperature keeps the function and activity of the organs of the body continuously and steadily at a high level and enhances the ability of the body to adapt to the environment. The body is controlled by the mechanism of temperature regulation to make the heat producing process and The process of heat dissipation is in balance, that is body heat balance, maintaining normal body temperature. If the body's heat production is greater than the heat dissipation, the body temperature will rise, and the temperature will decrease when the amount of heat is greater than the heat production, and the body temperature is stable at a new level until the heat production is rebalanced with heat dissipation. However, low temperature becomes a harm to the patient's anaesthesia. One of the important factors of surgical safety. There are many factors that lead to hypothermia in the perioperative period, such as the patient's own factors, the influence of narcotic drugs, the environmental factors, the type of operation, the blood transfusion, the infusion, and the use of a large number of irrigations. The perioperative hypothermia will bring many hazards to the patients: the increase of the time of the anesthesia recovery and the intraoperative bleeding. The incidence of surgical site infection increased, the incidence of infection was increased, acid-base imbalance, respiratory, circulation, nervous system complications increased, postoperative chills, fever incidence increased, even endanger the patient's life. How to strengthen intraoperative temperature monitoring and prevent hypothermia is becoming a hot spot in clinical anesthesia research. Inflatable insulation blanket relies on warm airflow in disease. The special warm flow layer is formed between the human skin, which makes the patient always in the warm environment and effectively prevents the body's total heat loss. This article is to observe the clinical effect of using inflatable heat insulation blanket to prevent hypothermia during the perioperative period of radical gastrectomy for patients with gastric cancer.
Method:
From September 2013 to February 2014, 100 patients with radical gastrectomy for gastric cancer in the Provincial Hospital Affiliated to Shandong University were collected, including 100 cases of radical gastrectomy for gastric cancer, ASA I to grade II, 64 men, 36 women, 45-72 years of age, 20-25 of body mass index and more than 3 hours of operation. They were randomly divided into heat preservation group and control group, 50 cases in each group. The room temperature was adjusted to 26 degree C, all infusion and flushing. The patient entered the room at room temperature. After the patient entered the operation room (TO), the nasopharyngeal temperature was measured, the nasopharyngeal surface anesthesia was inserted into the nasopharyngeal temperature monitoring probe, the nasopharyngeal temperature probe was inserted about 10-12cm. from the nasal cavity and monitored the electrocardiogram (ECG), heart rate (HR), the mean arterial pressure (MAP), pulse oxygen saturation (SpO2), the venous access and the static injection of the hydrochloric acid quetiquine 0.01mg. Kg-1. thermal insulation group. After the patient was admitted to the hospital, he covered the lower part of the body with inflatable blanket. The area was below the line between the anterior and posterior iliac spine, and the inflation temperature was 40 degrees C.
The two groups of patients were treated with the same method of anesthesia. Intravenous midazolam 0.04mg kg-1, CIS atracurium 0.2mg kg-1, etomidate 0.2mg kg-1, sufentanil 0.5 mu g. Kg-1. mask ventilation 3 minutes after tracheal intubation and mechanical ventilation. Adjust the ventilator parameters: respiratory frequency 10-12 times mmin-1, tidal volume 8-10mg kg-1, absorption ratio 1:2, oxygen Flow 2.0L. Min-1, adjust tidal volume and respiratory frequency according to the partial pressure of carbon dioxide (maintained between 35 to 45mmHg). The two groups of patients were pumped at a constant rate of propofol 8 to 12mg. Kg-1. H-1. At the end of the operation, the pump of propofol was stopped at 10 minutes before the end of the operation. The intravenous injection of atracurium 0.1mg. Kg-1 at the end of the operation was half an hour before the end of the operation. At the time, CIS CIS atracurium was stopped. When necessary, sufentanil was added to the sufentanil 0.1 g. Kg-1. when the patient had swallowing or choking. If a blood transfusion was needed in neostigmine lmg., the blood was placed in the thermostat for 15 minutes and then entered into the patient's body.
Recorded TO and 30min (T1), 60min (T2), 90min (T3), 120min (T4), 150min (T5), 150min (T5), 150min (T5), and the change of nasopharynx temperature. The amount of bleeding during the operation was recorded. The recovery time and shiver were recorded. The awakening time was from the operation. The patient's Steward awakening score was 4 minutes. The postoperative observation recorded the patient's fever and the number of postoperative hospital days, and the fever index was above 37.4 C. All data were analyzed by SPSS19.0 software, and the measurement data were expressed by X + s, and the single factor variance analysis was compared with the repeated measurements. The two sample t test was used in the comparison between the groups. The x2 test was used to compare the count data, and the difference between P0.05 was statistically significant.
Result:
The temperature of nasopharynx was measured in the two groups (P0.05). Compared with the two groups, the temperature of 30min (T1) after induction of anesthesia was significantly lower than that in the two groups (P0.05). The temperature of the control group was significantly lower (P0.05) at the end of the operation (T7) after the operation (T7) and the temperature of TO (TO). The temperature of the patients in the heat preservation group was also decreasing. But compared with the control group, the decline trend was slower. Compared with the control group, the control group and the heat preservation group were 120min (T4), 150min (T5), 180min (T6), and the end of the operation (T7), and the temperature difference was significant (P0.05). The temperature of the heat preservation group was significantly higher than that of the control group. The average arterial pressure (MAP) and heart rate (HR) of the two groups were not significant. Compared with the control group, the amount of intraoperative bleeding and the incidence of postoperative shiver decreased significantly (P0.05). The recovery time of the patients in the heat preservation group was significantly shortened (P0.05), the number of fever in 3 days after the operation was generally reduced and the number of days in hospital was shortened accordingly.
Conclusion:
In the perioperative period of radical gastrectomy, the use of inflatable heat insulation blanket can effectively prevent the occurrence of hypothermia, shorten the awakening time of anesthesia, reduce the amount of bleeding in the operation, reduce the postoperative chills, the incidence of fever, and shorten the time of hospitalization.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.2
本文编号：2124013
[Abstract]:Objective:
Temperature refers to the temperature inside the body. It is one of the vital signs of human life. The temperature of the body is relatively constant. The constant body temperature keeps the function and activity of the organs of the body continuously and steadily at a high level and enhances the ability of the body to adapt to the environment. The body is controlled by the mechanism of temperature regulation to make the heat producing process and The process of heat dissipation is in balance, that is body heat balance, maintaining normal body temperature. If the body's heat production is greater than the heat dissipation, the body temperature will rise, and the temperature will decrease when the amount of heat is greater than the heat production, and the body temperature is stable at a new level until the heat production is rebalanced with heat dissipation. However, low temperature becomes a harm to the patient's anaesthesia. One of the important factors of surgical safety. There are many factors that lead to hypothermia in the perioperative period, such as the patient's own factors, the influence of narcotic drugs, the environmental factors, the type of operation, the blood transfusion, the infusion, and the use of a large number of irrigations. The perioperative hypothermia will bring many hazards to the patients: the increase of the time of the anesthesia recovery and the intraoperative bleeding. The incidence of surgical site infection increased, the incidence of infection was increased, acid-base imbalance, respiratory, circulation, nervous system complications increased, postoperative chills, fever incidence increased, even endanger the patient's life. How to strengthen intraoperative temperature monitoring and prevent hypothermia is becoming a hot spot in clinical anesthesia research. Inflatable insulation blanket relies on warm airflow in disease. The special warm flow layer is formed between the human skin, which makes the patient always in the warm environment and effectively prevents the body's total heat loss. This article is to observe the clinical effect of using inflatable heat insulation blanket to prevent hypothermia during the perioperative period of radical gastrectomy for patients with gastric cancer.
Method:
From September 2013 to February 2014, 100 patients with radical gastrectomy for gastric cancer in the Provincial Hospital Affiliated to Shandong University were collected, including 100 cases of radical gastrectomy for gastric cancer, ASA I to grade II, 64 men, 36 women, 45-72 years of age, 20-25 of body mass index and more than 3 hours of operation. They were randomly divided into heat preservation group and control group, 50 cases in each group. The room temperature was adjusted to 26 degree C, all infusion and flushing. The patient entered the room at room temperature. After the patient entered the operation room (TO), the nasopharyngeal temperature was measured, the nasopharyngeal surface anesthesia was inserted into the nasopharyngeal temperature monitoring probe, the nasopharyngeal temperature probe was inserted about 10-12cm. from the nasal cavity and monitored the electrocardiogram (ECG), heart rate (HR), the mean arterial pressure (MAP), pulse oxygen saturation (SpO2), the venous access and the static injection of the hydrochloric acid quetiquine 0.01mg. Kg-1. thermal insulation group. After the patient was admitted to the hospital, he covered the lower part of the body with inflatable blanket. The area was below the line between the anterior and posterior iliac spine, and the inflation temperature was 40 degrees C.
The two groups of patients were treated with the same method of anesthesia. Intravenous midazolam 0.04mg kg-1, CIS atracurium 0.2mg kg-1, etomidate 0.2mg kg-1, sufentanil 0.5 mu g. Kg-1. mask ventilation 3 minutes after tracheal intubation and mechanical ventilation. Adjust the ventilator parameters: respiratory frequency 10-12 times mmin-1, tidal volume 8-10mg kg-1, absorption ratio 1:2, oxygen Flow 2.0L. Min-1, adjust tidal volume and respiratory frequency according to the partial pressure of carbon dioxide (maintained between 35 to 45mmHg). The two groups of patients were pumped at a constant rate of propofol 8 to 12mg. Kg-1. H-1. At the end of the operation, the pump of propofol was stopped at 10 minutes before the end of the operation. The intravenous injection of atracurium 0.1mg. Kg-1 at the end of the operation was half an hour before the end of the operation. At the time, CIS CIS atracurium was stopped. When necessary, sufentanil was added to the sufentanil 0.1 g. Kg-1. when the patient had swallowing or choking. If a blood transfusion was needed in neostigmine lmg., the blood was placed in the thermostat for 15 minutes and then entered into the patient's body.
Recorded TO and 30min (T1), 60min (T2), 90min (T3), 120min (T4), 150min (T5), 150min (T5), 150min (T5), and the change of nasopharynx temperature. The amount of bleeding during the operation was recorded. The recovery time and shiver were recorded. The awakening time was from the operation. The patient's Steward awakening score was 4 minutes. The postoperative observation recorded the patient's fever and the number of postoperative hospital days, and the fever index was above 37.4 C. All data were analyzed by SPSS19.0 software, and the measurement data were expressed by X + s, and the single factor variance analysis was compared with the repeated measurements. The two sample t test was used in the comparison between the groups. The x2 test was used to compare the count data, and the difference between P0.05 was statistically significant.
Result:
The temperature of nasopharynx was measured in the two groups (P0.05). Compared with the two groups, the temperature of 30min (T1) after induction of anesthesia was significantly lower than that in the two groups (P0.05). The temperature of the control group was significantly lower (P0.05) at the end of the operation (T7) after the operation (T7) and the temperature of TO (TO). The temperature of the patients in the heat preservation group was also decreasing. But compared with the control group, the decline trend was slower. Compared with the control group, the control group and the heat preservation group were 120min (T4), 150min (T5), 180min (T6), and the end of the operation (T7), and the temperature difference was significant (P0.05). The temperature of the heat preservation group was significantly higher than that of the control group. The average arterial pressure (MAP) and heart rate (HR) of the two groups were not significant. Compared with the control group, the amount of intraoperative bleeding and the incidence of postoperative shiver decreased significantly (P0.05). The recovery time of the patients in the heat preservation group was significantly shortened (P0.05), the number of fever in 3 days after the operation was generally reduced and the number of days in hospital was shortened accordingly.
Conclusion:
In the perioperative period of radical gastrectomy, the use of inflatable heat insulation blanket can effectively prevent the occurrence of hypothermia, shorten the awakening time of anesthesia, reduce the amount of bleeding in the operation, reduce the postoperative chills, the incidence of fever, and shorten the time of hospitalization.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.2
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