围术期体温保护对腹腔镜胃癌根治术患者凝血功能的影响

Effect of perioperative warming on hemostasis in patients undergoing laparoscopic radical gastrectomy

目的观察围术期体温保护对腹腔镜胃癌根治术患者凝血功能的影响。方法择期行气静吸全麻腹腔镜胃癌根治术患者80例,随机分成:保温组(H组)和对照组(N组),每组40例。H组患者入室后至手术结束期间予充气式保温毯进行保温,双下肢覆布包裹。静脉输注液体、腹腔冲洗液加温至37℃。N组患者与实验组于相同室温下、双下肢覆布包裹外不予其他加温措施。监测患者入室(TO),麻醉诱导前(T1),诱导后(T2)及诱导后30分钟(T3)、60分钟(T4)、90分钟(T5)、120分钟(T6)、150分钟(T7)、180分钟(T8),手术结束(T9)各时点同侧鼓膜温度。分别于T0、T5、T8测定凝血四项即凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分促凝酶原激酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FBG)和血栓弹力图(thrombelastogram,TEG)。记录患者清醒后是否出现寒战。结果体温:各组患者不同时间点(组内)体温比较差异有统计学意义(P<0.05)。从各时点(组间)看,T3、T4、T5、T6、T7、T8、T9七个时点H组鼓膜温度较N组高,有统计学差异(P<0.05)。凝血四项:各组患者不同时间(组内)的PT、TT、FBG的比较具有统计学意义(P<0.05),PT术中较术前延长,TT术中较术前缩短,FBG术中较术前下降。从各时点(组间)看,凝血四项各指标在各时点比较均无有意义的差别。TEG:H组患者术中R比术前延长,比较有显著差别。但组内不同时间的K、a、MA、CI、LY30的比较不具有统计学意义。从各时点(组间)看,TEG各指标两组间比较也没有显著差异。两组患者术后寒战发生率差别有统计学意义(P<0.05),H组低于N组。结论体温保护可以维持腹腔镜胃癌根治术患者围术期体温相对稳定,有效防止低体温及寒战的发生,但对凝血四项和TEG各指标可能没有影响。

Objective To observe the influence of perioperative warming on blood coagulation function in patients with laparoscopic-assisted radical gastrectomy under general anesthesia. Method Eighty laparoscopic assisted radical gastrectomy patients with ASA Ⅰ-Ⅱwere randomly divided into warming group （group H） and control group （group N）,with 40 patients each. In warming group, the WarmTouch warming system （Nellcor, USA） was used. The fluid infused during operation were warmed to 37℃. The peritoneal flushing liquid lavaged during operation were warmed to 37℃.In control group （group N）, no warming was provided except cloth wrapped on lower limbs. Tympanic temperature measurement was started from arriving the room, before and after induction and every 30 minutes after induction until the end of operation. PT, TT, APTT, FBG, TEG were respectively performed before induction, 90min and 180min after induction. Recorded shiver in postanesthesia care unit. Result There were statistically significant differences in temperatures at different observational time between groups （P〈0.05）. The tympanic temperatures in group H were higher than those of the group N at T3, T4, T5, T6, T7, and T8. The difference was statistically significant （P〈0.05）. There were statistical significant differences in PT, TT, and FBG at different observational time between the two groups （P〈0.05）. As for the parameters in the intraoperative period, PT prolonged, TT shortened, and FBG decreased, when they were compared with that of the preoperative period. As for the fluctuations within the observational time sequence, changes in these parameters were generally unremarkable. Patients’ characters of TEG were regarded as without statistical difference in the baseline. The intraoperative R prolonged in group H （P〈0.05）, rather than in the group N. In comparison for K,α, MA, CI, and LY30 within different observational time, two groups did not have statistical significance. At the same time point, each index of TEG between two groups were no significant difference. Comparing with warming group, the control group has a higher ratio of postoperative chill （P〈0.05）. Conclusion Perioperative warming prevent the happening of hypothermia and chills effectively in patients following laparoscopic radical gastrectomy. But it has no significant effects on blood coagulation function and TEG parameters.