综合保温对腹腔镜子宫肌瘤剔除术患者应激反应的影响

Influence of Composite Thermal Insulation on Stress Response of Patients Undergoing Uterine Myomectomy through Laparoscopy

目的评价综合保温对腹腔镜子宫肌瘤剔除术患者应激反应的影响。方法选择择期行腹腔镜子宫肌瘤剔除术患者80例,随机分成综合保温组(观察组)和常规保温组(对照组)各40例,综合保温组在常规保温基础上采取身下铺循环水毯,加温术中使用的输血、输液及冲洗液至37℃的保温措施。两组分别记录入室后10min、气腹前10min、气腹后10min、术毕放气后5min、术后3h的鼻咽温度,两组入室后10min、气腹前10min、气腹后10min、术毕放气后5min在非输液侧肢体采集静脉血用放免方法检测肾上腺素和去甲肾上腺素含量,并检测患者入室和术毕时凝血酶原时间(prothrombin time,PT)、部分凝血酶原时间(activated partial thromboplastin time,APTT)和纤维蛋白原(fibrinogen,FBG)。结果两组患者自气腹后10min起鼻咽温度比较对照组均低于观察组(P<0.05)。观察组麻醉复苏时间短(P<0.05)。两组患者气腹后肾上腺素含量均有所上升,术毕放气后5min肾上腺素含量尚未恢复至入室后10min水平,观察组患者气腹后10min和术毕放气后5min升高的幅度较对照组小(P<0.05)。两组患者气腹后10min去甲肾上腺素含量明显高于入室前10min水平,术毕放气后5min基本恢复,气腹后10min观察组患者去甲肾上腺素含量明显低于对照组(P<0.05)。两组患者入室后10minAPTT、FBG比较差异无统计学意义(P>0.05),术毕放气后5min均延长,观察组延长的幅度较对照组小(P<0.05)。结论腹腔镜子宫肌瘤剔除术患者应用综合保温措施有利维持手术中体温的稳定,减轻腹腔镜手术中的应激反应。

Objective To assess the influence of composite thermal insulation on the stress response of patients undergoing uterine myomectomy through laparoscopy. Methods 80 qualified cases were randomly divided into the composite insulation group （observation group） and the conventional group （control group）, each with 40. The nasopharyngeal temperature of both groups after the patients entered the operation theatre, before and after the pneumoperitoneum, at the end of the operation, and 3 h after the operation, were recorded. Also recorded were the content of epinephrine and norepinephrine through the venous blood collected from the non-infusion limb at all the above-mentioned time points except 3 h after the operation, and the PT, APTT and FBG at the entry of the operation theatre and the end of the operation. Results Ten minutes after the pneumoperitoneum, the nasopharyngeal temperature of the control group remained lower than that of the observation group （P〈0.05）, and the time of recovery from anaesthesia of the former was shorter （P〈0.05）. After the pneumoperitoneum, the levels of epinephrine and norepinephrine of the observation group were lower than those of the control group （P〈0.05）, with those of both groups being higher than those at the entry of the operation theatre, which returned to the original value at the end of the operation. The differences in PT, APTT, and FBG at the patients＇ entry of the operation theatre had no statistical significance （P〉0.05）, all of which increased after the end of the operation,with the margin of the increase of the observation group smaller （P〈0.05）. Conclusion Composite thermal insulation can lessen the stress response of patients undergoing uterine myomectomy through laparoscopy.