双侧人工关节置换术病人术中应用温热液体对术后寒战及心肌耗氧量的影响

Influence of applying warm fluids during operation on postoperative shivering and myocardial oxygen consumption of patients accepting bilateral artificial joints replacement

[目的]明确术中应用温热液体对择期行双侧人工关节置换术病人术后寒战及心肌耗氧量的影响,为临床术中病人应用温热液体提供依据。[方法]选取择期行双侧人工关节置换术(双侧髋关节置换术或双侧膝关节置换术)病人88例,随机分为温热组和常温组。温热组术中静脉输入温度为36.5℃～37.5℃的温热液体(包括库存血),并采用温度为37.0℃的恒温冲洗液进行术区冲洗;常温组术中静脉输入常温(22℃～24℃)液体及库存血,并用同温度的常温冲洗液进行术区冲洗。观察术后寒战及寒冷不适情况、心肌耗氧量的变化。[结果]常温组病人术后寒战及寒冷不适感发生率明显高于温热组(P<0.05或P<0.01),寒战程度及寒冷不适度较温热组严重(P<0.01);常温组病人心肌耗氧量自术后10min起均明显高于温热组(P<0.05),且术后2h内心肌耗氧量均明显高于麻醉诱导后值(基础值),而温热组仅在术后10min时高于基础值。[结论]双侧人工关节置换术病人术中给予温热液体有利于降低术后寒战发生率,减轻寒战严重程度及寒冷不适度,降低心肌耗氧量,缩短心肌耗氧量升高持续时间。

Objective：To find out the influence of intraoperative application of warm fluids on postoperative shivering and myocardial oxygen consumption in patients accepting elective bilateral artificial joints replacement,so as to provide some bases for such patients in clinical to use warm fluids during operation.Methods：A total of 88 patients accepting selective bilateral artificial joints replacement（bilateral hip joints replacement,or bilateral knee joints replacement）were selected and divided into warm group and normal temperature group randomly.Patients of warm group accepted intraoperative intravenous fluids infusion at the temperature of 36.5~37.5 degrees centigrade（including bank blood）,and using thermostat fluids at temperature of 37.0 ℃ for washing operative field.Patients of normal temperature group received intravenous fluids infusion and bank blood during operation at normal temperature（22~24 degrees centigrade）,and normal temperature fluids for washing operative field.Then postoperative shivering and cold discomfort,myocardial oxygen consumption changes of all cases were observed.Results：The incidence of postoperative shivering and cold discomfort of patients in normal temperature group were significantly higher than that of warm group（P0.05 or P0.01）.Shivering and cold discomfort of patients in normal temperature group were more severe than that in warm group cases（P0.01）.Myocardial oxygen consumption in normal temperature group patients since 10 minutes after operation was significantly higher than that of warm group cases（P0.05）.Myocardial oxygen consumption in normal temperature group patients within 2 hours after operation was significantly higher than the value of after anesthesia induction（base value）.However,myocardial oxygen consumption of patients in warm group was higher than the base value only within 10 minutes after operation.Conclusions：Patients accepting bilateral artificial joints replacement received warm fluids during operation could reduce the incidence of postoperative shivering,relieve the severity of shivering and cold indisposition,lower the myocardial oxygen consumption volume,and shorten the duration of myocardial oxygen consumption step-up.