综合保温措施在晚期肝泡状棘球蚴病自体肝移植围术期的应用

Application of comprehensive thermal insulation measures for maintaining body temperature during period of liver transplantation

目的：探讨综合保温措施在晚期肝泡状棘球蚴病自体肝移植围术期的应用效果,为提高手术成功率提供理论依据。方法选取18例晚期肝泡状棘球蚴病行自体肝移植术的患者,采用适度提高室温、身体包裹、输液加温、湿敷料加温、冲洗液加温与铺置保温毯的综合保温措施,通过监测肛温、鼻咽温、心率、血压、pH值,验证此法是否有效。结果在新肝再灌注5 min时,患者鼻咽温、肛温分别为：（35.78±0.69）,（35.97±0.65）℃,pH值为（7.29±0.08）,均显著下降；心率加快为（100.58±5.47）次/min,差异有统计学意义（P〈0.01）。在无肝期后30 min和新肝再灌注5 min时,收缩压分别为（82.21±10.45）,（83.59±12.71）mmHg,均显著下降,差异有统计学意义（P〈0.01）；以上指标均在新肝再灌注30 min后恢复正常。结论在晚期肝泡状棘球蚴病自体肝移植围术期,综合保温措施的应用能有效地预防术中低体温的发生。

Objective To evaluate the effects of comprehensive thermal insulation measure for maintaining body temperature during perioperative period of liver transplantation for the late hepatic alveolar echinococcosis, and provide theoretical basis for improving the success rate of the operation. Methods A total of 18 patients undergoing liver transplantation for the late hepatic alveolar echinococcosis received comprehensive thermal insulation measure. The changes of nasopharyngeal and rectal temperature, pH, heart rate and blood pressure were monitored in the whole process of operation to justify the effective. Results After 5 min the new liver reperfusion, the nasopharyngeal and rectal temperature were （35. 78 ± 0. 69） and （35. 97 ± 0. 65）℃, and the value of pH decreased dramatically to （7. 29 ± 0. 08）, but the heart rate increased to （100. 58 ± 5. 47） times/min （P〈0. 01）. The systolic blood pressure were （82. 21 ± 10. 45） and （83. 59 ± 12. 71） mmHg during no liver period and 5 min new liver reperfusion （P〈0. 01）, but all above indexes became normal after 30 min reperfusion. Conclusions During perioperative period of liver transplantation for the late hepatic alveolar echinococcosis, comprehensive thermal insulation measure can maintain the body temperature and other vital signs and effectively prevent the occurrence of intraoperative hypothermia.