不同保温方法对经典非转流原位肝移植术中患者体温变化的影响

Effect of different ways of homoiothermism on patients during classic unturn-flowing orthotopic liver transplantation

【目的】观察不同保温方法对经典非转流原位肝移植（OLT）术中患者体温变化的保护效果。【方法】56例晚期肝病患者（ASAⅢ～Ⅳ级）,随机分为两组各半。常规电温毯组保温范围为患者背部,另外四肢还用棉垫包裹;大范围恒温毯组保温范围包括患者前胸乳头以上部位、双肩及四肢。两组患者还同时采用其它保温方法,包括头部保温、静脉输液加温与温盐水腹腔冲洗等。【结果】OLT手术中,两组患者在无肝期30 min和新肝期30 min体温均有所下降,与切皮前比较差异有统计学意义（P〈0.01）。常规电温毯组患者体温下降（1.6±0.3）℃,大范围恒温毯组体温下降（1.2±0.2）℃（P〈0.05）。两组均有患者出现体温过低现象（〈34℃）,其中常规电温毯组8例,大范围恒温毯组仅2例（P〈0.05）。【结论】OLT术中患者易发生体温下降。与常规电温毯保温法相比,大范围恒温毯保温系统可减少体温下降的幅度,并减少体温过低的发生率。

[Objective] To observe the effects of different ways of homoiothermism on body temperature of patient during classic unturn-flowing orthotopic hver transplantation（OLT）. [Methods] A total of 56 patients with ASA Ⅲ or Ⅳ grade were randomly divided into two groups. In routine electric hot carpet group, body temperature was kept with carpet covering the back and cotton cushion covering the arms and legs. In electric warm-keeping system group, more area of body warming included anterior chest wall above nipple, shoulders and four hmbs. Injected liquid warming and abdominal cavity washing with warm salt-water were performed in both groups. [Results] Body temperature was lower in 30 min after hver was removed and in 30 min after reperfusion of the graft than that of before skin incision（ P 〈 0.01）. During the operation, the body temperature dropped（ 1.6 ± 0.3） ℃ in routine electric hot carpet group and（ 1.2 ± 0.2） ℃ in more area carpet electric warm-keeping system group（ P 〈 0.05）. Eight cases had much lower temperature（ 〈 34 ℃ ）in routine electric hot carpet group and only two case in more area electric warm-keeping system group（ P 〈 0.05）. [Conclusions] Lowering of body temperature in patient during OLT is very easly. Compared with routine electric hot carpet, more area electric warm-keeping system would decrease the degree of lowering of body temperature and the incidence of much lower of body temperature.