保温时机的选择对不停跳冠状动脉搭桥患者术后恢复情况的影响

Heat Preservation Time Herein for Coronary Artery Bypass Patients on the Influence of the Postoperative Recovery

目的 探讨围手术期如何通过选择合适的保温时机来减少低温对不停跳冠脉搭桥病人机体的不良影响,使机体尽快从手术创伤中恢复.方法 在我院接受不停跳冠状动脉搭桥术的病人中,筛选出老年患者30例,随机分为A,B,C3组.A组病人在麻醉诱导后,手术开始时即使用热传导变温水毯加热,手术过程输入液体（除血制品外）均应用静脉输液加温器加热至37.0℃.术中病人体温回升后通过调节变温水箱的水温,使患者鼻咽温度保持在36.5℃～37.5℃,回ICU后只采取覆盖棉被等敷料保温.B组术中不采取积极的保温措施,进入ICU后立即应用热传导变温水毯,覆盖棉被等保温敷料使病人体温尽快回升,然后通过调节变温水毯温度或增减保温敷料使患者鼻咽温度保持在36.5℃～37.5℃.C组术中及术后复合采取上述保温措施使患者的鼻咽温度恒定保持在36.5℃～37.5℃.观察手术时间、术后引流量,使用呼吸机时间,ICU停留时间,总住院天数等指标.结果 在手术时间、使用呼吸机方面A与C组比较,差异无显著性（P＞0.05）,与B组比较,差异均有显著性（P＜0.05）.在引流量、ICU停留天数、总住院天数方面,C组明结果显优于A组,A组明显优于B组,组间比较,差异均有显著性（P＜0.05）.结论 术中积极保温效果明显优于术后恢复期的保温,但无法替代围手术期持续保温对机体的有益作用.

Objective To expore how to choose the right time through heat preservation to reduce temperature not arrest CABG patients the bad influence of the body during the perioperative. And to make the body recovered from surgery, as soon as possible. Methods Coronary artery bypass surgery patients who were in our hospital were in elderly patients, 30, randomly divided into A, B, and C three groups. Patients Group A after surgery has narcotic induction, which used heat conduction and warm water heating, operation process blanket input liquid （ except the blood product） have the applieation intravenous infusion heater heated to 37.0~C. Group B did not take actively insulation measures, after been in the ICU. Immediately application about heat conduction become warm water blankets, covered quilts insulation dressing make the patientg temperature rise, and then as soon as possible by adjusting the temperature increase or decrease or warm water blanket was heat preservation dressing to make patients nose pharynx temperature was maintained at 36.5℃- 37.5℃. Group C preoperative and postoperative composite took the heat preservation measures, so that patients with the nose pharynx keeped constant temperature in 36.5 ℃- 37.5℃. Operation time, postoperative patients lead flow, the ventilator, and ICU stay time time were observed. Results In the time of the op- eration, used breathing machine A and C group was no statistical difference { P 〉 0.05 ）. But compared with the group B, there was statisticallysignificant { P 〈 0.05 ）. In the lead, ICU stay flow, days of the total number in hospital, the results showed that the group C was better than Group A, and Group A was better than group B. Comparison between groups were statistically significant. Conclusion Intraoperative positive heat preservation effect is better than the heat preservation of the recovery,but can not replace perioperative and continue to make the beneficial effects on the heat preservation.