肝移植术后患者体温监测分析及护理对策

Temperature Monitor Analysis and Nursing Strategy on Liver-transplanted Patients

目的了解肝移植患者术后3d内体温变化规律，分析体温变化的影响因素，总结肝移植术后有效的体温监测及护理措施，为制定规范的肝移植术后护理程序提供依据。方法采用多功能心电监护仪，记录147例肝移植术后转入ICU的患者术前、术后返ICU后即刻，及术后4、8、12、16、20、24、48、72h时间点的中心温度（肛温），并进行统计分析。结果肝移植患者术后3d内的总体体温变化有统计学差异（P〈0．01）。患者术后转入ICU时，体温降低明显（P〈0．01），66．67％的患者出现低体温。人ICU后4h总体体温迅速回升至术前水平，8h后体温较术前持续升高，以术后20h升高最为明显，直到术后24h体温开始回降；术后4～24h内，体温〉37．5℃的患者大幅增多（P〈0．01），至48h后体温基本降至术前水平。结论肝移植患者术后体温变化幅度大，体温异常者所占比率高。为避免异常体温对机体的不良影响，应加强肝移植患者术后体温监测，给予预见性护理，使肝移植患者体温管理规范化。

Objective To learn the patients＇ temperature fluctuating rules in three days after liver transplantation,analyze the relevant influencing factors of the temperature changes, and summarize the policies of the temperature monitor and nursing,so as to provide the basis for the clinical nursing program of liver transplanting. Methods Multifunctional ECG monitor was used to observe the 147 liver-transplanted ICU patients＇ core temperatures at the time points before operation,after operation immediately and at 8 points （4,8,12,16.20,24.48.72 h）. The collected data was statistically analyzed. Results The fluctuating temperature in three days had a significant difference（P〈0.01）. The patients＇ temperature descended greatly when entering ICU （P〈0.01） and 66.67 percent of them had hypothermia. After entering ICU,the patients＇ overall temperature returned to the level of pre-operation rapidly in 4 h,which continued increased in 8 h and ascended most significantly in 20 h. Then the temperature began to descend in 24 h. The number of patients with temperature over 37. 5 increased significantly in 4-24 h （P〈 0. 01）, and the temperature returned to the level before operation again in 48 h. Conclusion The liver-transplanted patients＇ temperature changes greatly after operation and the ratio of abnormal temperature is high. To avoid damages,we should strengthen the temperature monitor and standardize the patient nursing management.