温热输液及冲洗对人工关节置换术患者术中体温及失血量的影响

Effects on intraoperative body temperature and blood loss of warmer fluids applied to the patients undergoing prosthetic replacement of joints

目的 明确术中温热输液及冲洗对双侧人工关节置换术患者同期体温及失血量的影响,为临床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（双髋或双侧膝关节置换术）患者,随机分为温热组（n=44）和常温组（n=44）.温热组患者术中输入36.5～37.5 ℃的温热液体（包括库存血）,并采用37 ℃的恒温冲洗液进行术区冲洗;常温组患者术中输入22～24 ℃液体及库存血,并用同温度的冲洗液进行术区冲洗.观察两组患者在麻醉诱导后、麻醉30 min、术中1,2,3 h、术毕即刻6个观察时相体温变化及术中失血量.结果 温热组术中体温变化不明显,常温组体温自术中1 h起开始明显下降,差异有统计学意义（P〈0.05）.温热组体温在术中1,2,3 h及术毕即刻4个观察时相均高于常温组,差异有统计学意义（P〈0.05）;术中2,3 h及术毕即刻,温热组低体温发生率均低于常温组,差异有统计学意义（P〈0.01）;温热组术中失血量为（611.63±392.31）ml,常温组为（923.42±522.50）ml,差异有统计学意义（P〈0.01）.结论 术中应用温热液体有利于维持双侧人工关节置换术患者术中体温恒定,降低低体温发生率,减少术中失血量,术中患者如无低温要求可选择此温度液体.

Objective To certify the effects of warmer fluids on body temperature, blood loss of patients undergoing bilateral prosthetic replacement of joints and provide the basis for the warmer fluids＇ intraoperative application.Methods Patients having selective bilateral prosthetic replacement of joints were divided into two groups randomly, including the warmer group （n = 44） and ambient temperature group （n =44）.The forty-four patients in warmer group were infused with fluids of 36.5 ～ 37.5 ℃, and flushed with fluids of 37 ℃, while the forty-four patients in ambient temperature group were infused and flushed with fluids of 22 ～24 ℃ intraoperatively. The blood loss and the change of body temperature between the two groups were investigated during different intraoperative phases.Results The body temperature of warmer group did not change obviously, however, the other group declined evidently（P 〈 0.05）.The body temperature of warm group were higher than the other group from the first hour intraoperatively （P 〈 0.05）.The incidence of hypothermia of warm group was lower than the ambient temperature group at the same phase from the second hour intraoperatively（P 〈0.01）.The blood loss of warm group was （611.63 ± 392.31）ml, when the other was （923.42 ± 522.50） ml and the difference reached statistical significance（P 〈 0.01）.Conclusions Warmer fluids applied to patients undergoing bilateral prosthetic replacement of joints intraoperatively can maintain the body temperature steady and reduce the occurrence of hypothermia and blood loss.