妇科腹腔镜术中体温变化

The changes of body temperature during gynecologic laparoscopic surgery

目的探讨妇科腹腔镜术中体温变化。方法监测86例妇科腹腔镜手术患者术中不同部位中心温度肛温(T1)腋温(T2)变化。室温维持23～24℃,二氧化碳灌注维持腹腔内压14～16mmHg。选用硬膜外麻醉。分别记录手术时间、术中二氧化碳用量、手术冲洗液量,体温情况。结果术中体温逐渐下降,与术前差异有统计学意义(T1P<0.01,T2P<0.05),且随着二氧化碳用量增加,降低更为明显。术中T1下降0.5～2.5℃,其中10例下降0.5℃(12%),40例下降1℃(46%),26例下降1.5℃(30%),10例下降2.5℃(12%)。T2下降0.2～1.5℃,其中23例下降0.2℃(27%),34例下降0.4℃(40%),12例下降0.6℃(14%),9例下降0.8℃(10%),8例下降1.5℃(9%)。腹腔冲洗前后体温变化比较,冲洗后与冲洗前体温下降度差异有统计学意义(T1P<0.05,T2P<0.01)。结论应重视妇科腹腔镜术中的体温改变,操作时尽量减少二氧化碳外泄导致的用量增多,可考虑使用气体加温器,尤其应避免腹腔冲洗的同时高流量二氧化碳灌注。

Objective To investigate the changes of body temperature during gynecologic laparescopie surgery.Methods 86 patients undergoing gynecologic laparescopic surgery were studied by monitor the temperature in two places-anus temperature （T1）and armpit temperature （T2）.Room temperature was kept between 23 - 24℃ and CO2 gas delivering express was kept between 14- 16 mmHg. Chosen epidural anesthesia. Operating time, the volume of CO2 gas delivered, the volume of douche fluid and T1,T2 were recorded. Results The patient xore temperature daring operation were significantly lower than the temperature before operation （T1 P 〈 0.01,T2 P 〈 0.05 ） and more CO2 gas delivered, temperature changed. T1 decreased 0.5 ℃ in 10 patients （ 12 % ）, 1℃ in 40 patients （46%）, 1.5% in 26 patients （30%） ,2.5℃ in 10 patients （ 12% ） .The least change was 0.5℃ and the most change was 2.5℃ ,12 decreased 0.2℃ in 23 patients（27% ） ,0.4℃ in 34 patients （40%） ,0.6℃ in 12 patients （ 14% ） ,0.8℃ in 9 patients （ 10% ）, 1.5℃ in 8 patients （9%）, The least change was 0.2℃ and the most change was 1.5℃. The temperature changes were compared when laparescopie surgery with or without irriagtion of peritoneal cavity.T1 was significantly decreased after irrigation of peritoneal cavity, （ P 〈 0.05 ） and also T2 （ P 〈 0.01 ）. Conclusion Changes of body temperature during gynecologic laparescopic surgery should take into account.Minimizing amount of gas leakage,considering the use of gas heating device and especially avoiding high flow CO2 gas delivery while irrigating peritoneal cavity were advantages to reduce the incidence of intmoperative heat loss.