老年患者术中低体温的临床观察及护理对策

CLINICAL OBSERVATION AND NURSING FOR INTRAOPERATIVE ELDERLY PATIENTS WITH HYPOTHERMIA

目的观察两种输液方法对行开腹卵巢切除术或子宫切除术的老年患者围手术期体温、凝血功能的影响,探讨适宜的预防围手术期低温的护理方法。方法选择择期开腹卵巢或子宫切除术的老年患者40例,随机平分为A、B两组,A组术中输注预热至40℃的6%羟乙基淀粉和复方乳酸钠;B组输注室温的同样液体。患者入室输注6%的羟乙基淀粉5ml/kg后行腰-硬联合麻醉(CSEA),再输注6%羟乙基淀粉5ml/kg后切皮,随后输注6%羟乙基淀粉至1000ml,最后输注复方乳酸钠。记录入室时、CSEA时、手术中30min、60min、90min及120min鼻咽温度(NT)及腋部与手指温差(△T),同时记录术前、术后凝血酶原时间(PT)和活化部分凝血激酶时间(APTT)、手术失血量及寒颤发生率。结果麻醉后A组各时点NT明显高于B组(P<0.05)。A组术后PT、APTT较B组明显缩短(P<0.05),出血量、寒颤发生率明显低于B组(P<0.05)。结论输注预热胶体及晶体液能有效提高患者术中的鼻咽温度,减少外周血管的痉挛,改善凝血功能,减少术中出血量及寒颤的发生率,降低术中低体温的发生,是一种确切实用的围手术期体温护理方法。

Objective To observe the effects of two infusion methods for perioperative body temperature and blood coagulation of elderly patients who were performed laparotomy ovariotomy or hysterectomy and to explore the appropriate nursing methods to prevent perioperative hypothermia. Methods 40 elderly patients who were performed laparotomy ovariotomy or hysterectomy were randomly divided into Group A and Group B. Group A was infused with 6% hetastarch and compound sodium lactate preheated to 40℃ and Group B was given the same liquid at the room temperature. The patient were infused with 6G hetastarch of 5ml/kg for patients, underwent combined spinal-epidural anesthesia （CSEA） , were infused with 60/oo hetastarch of 5ml/kg, received skin incision, were infused with 6% hetastarch up to 1000ml and compound sodium lactate. The nasopharyngeal temperature （NT） and axilla-finger temperature difference （△T） at the times of recording entering operating-room, CSEA, skin incision and at 30th , 60th , 90th and 120th minutes during the operation. The preoperative and postoperative prothrombin time （PT） and the activated partial thromboplastin time （APTT）, the volume of blood loss in operation and incidence of shivering were recorded simultaneously. Results After anesthesia, NT at every time point in Group A were significantly higher than that in Group B （ P〈0.05）. After operation, PT and APTT in group A were significantly shorter than in group B （ P 〈0.05）. The blood loss, shivering incidence rate in Group A were significantly lower than in Group B （ P 〈0.05）. Conclusion Infusing preheated colloid and crystal liquid can effectively promote patients＇ nasopharyngeal temperature in operation, reduce spasm of peripheral blood vessel, improve blood coagulation function, reduce blood loss in operation, shivering incidence rate and the occurrence of hypothermia. It is a precise and practical body temperature nursing method in perioperative period.