温灌洗液降低经皮肾镜取石术围术期寒战的发生率

The lukewarm lavage reducing percutaneous nephrolithotomy lithotomy perioperative chills incidence

目的探讨温灌洗液在经皮肾镜取石术（percutaneous nephrolithotripsy，PCNL）中的应用效果。方法120例全麻下PCNL患者，采用随机数字表法随机分为3组（每组40例）：I组（室温静脉输液和室温灌洗液组）、Ⅱ组（室温静脉输液和温灌洗液组）、Ⅲ组（温静脉输液和温灌洗液组）。各组均在室温相同的条件下麻醉，统计静脉输液总量和灌洗液总量，同时记录有创平均动脉压（meanarterial pressure，MAP）、中心静脉压（central venous pressure，CVP）、围术期平均体温以及术后寒战发生的比例。结果I、Ⅱ组患者苏醒期平均体温低于术中平均体温0．7oC左右，组内比较差异有统计学意义（P〈O．05）；llI组患者苏醒期与术中平均体温相比变化不大，组内比较差异无统计学意义（P〉0．05）。I组患者术中及苏醒期平均体温低于Ⅱ、Ⅲ组，术后寒战发生的比例I组为57．5％、II组为32．5％、m组为17．5％，组间比较差异有统计学意义（P〈0．05）；U组患者术中和苏醒期平均体温以及术后寒战发生的比例与Ⅲ组比较差异有统计学意义（P〈0．05）。结论温灌洗液在PCNL中的应用可以有效减少围术期寒战的发生率，对患者呼吸、循环功能无显著影响，安全有效。

Objective To observe the effect to patients of applying lukewarm lavage fluid in percutaneous nephrolithotomy （PCNL）. Methods 120 case s of undergoing PCNL patients who received general anesthesia and endotracheal intubation using random number table, were randomly divided into three groups（n=40）. Intravenous fluids and lavage group at room temperature used in group Ⅰ . Room temperature intravenous fluids and lukewarm lavage used in group Ⅱ. Lukewarm intravenous fluids lavage used in group Ⅲ. Patients in each group received general anesthesia with intubation at the same room temperature. Total volume of intravenous fluids and lavage during operation were recorded, as well as patient＇s temperature, mean arterial pressure （MAP） and central venous pressure （CVP）. The mean temperature during surgery and waking period, and the incidence of postoperative shivering were taken into statistical analysis. Results Temperature in group I and Ⅱ during waking period significantly lower than （P〈O.05） mean temperature during surgery 0.7 ℃. Group I patients recovery period average body temperature less than group Ⅱ and Ⅲ, the proportion of chills occur of postoperative, group I 57.5%, group Ⅱ 32.5%, group Ⅲ 17.5%. Between the two groups statistically were significant different （P〈0.05）. The mean temperature during surgery and waking period in group I , as well as the incidence of postoperative shivering, were significantly lower than （P〈0.05） those in group Ⅱ and III. Conclusions Lukewarm lavage can be effective in reducin~ the incidence of postoperative shivering in PCNL, without side effect to patient＇s perioperative circulatory function.