老年患者全膝关节置换围术期不同输血输液温度对术后恢复质量的影响

Effect of different temperature of fluids and blood infusion on postoperative recovery quality in elderly patients undergoing total knee arthroplasty

目的评价老年患者全膝关节置换（total knee arthroplasty,TKA）围术期接受不同温度的输血输液对患者术后恢复质量的影响。方法选择择期行单侧TKA的患者156例,男42例,女114例,年龄65-85岁,ASAⅠ或Ⅱ级,随机分为三组：常温组（NT组）、恒温组（CT组）和加温组（WT组）,每组52例。NT组采用室温（22-24℃）下输血输液及室温冲洗液对术区进行冲洗;CT组采用加温装置使输血输液温度升高至37℃,并使用37℃冲洗液行术区冲洗;WT组使输血输液温度升高至37℃,并使用39℃冲洗液行术区冲洗。观察患者术前（T0）,手术开始30min（T1）、手术开始1h（T2）,术毕30min（T3）及术毕1h（T4）的鼻咽温度,记录患者自主呼吸恢复时间、呼之睁眼时间、意识清醒时间、拔管时间及Steward评分。采用PQRS量表评估患者拔管后15、40min及术毕1、3、30d的认知功能恢复情况。结果与T0时比较,T1-T4时三组患者的鼻咽温度均明显降低（P〈0.05或P〈0.01）;T1-T4时CT组和WT组的鼻咽温度明显高于NT组（P〈0.01）;T4时WT组的鼻咽温度明显高于CT组（P〈0.05）。WT组意识完全清醒时间明显短于NT组（P〈0.01）,Steward评分明显高于NT组（P〈0.05）。CT组和WT组的呼之睁眼时间、自主呼吸恢复时间明显短于NT组（P〈0.01）。与拔管前比较,三组患者在拔管后15、40min及术后1、3、30d的认知功能恢复质量评分均明显升高（P〈0.01）,CT组和WT组在拔管后15、40min及术后1、3、30d的认知功能恢复质量评分明显高于NT组（P〈0.05）,WT组术后30d的认知功能恢复质量评分明显高于CT组（P〈0.05）。结论 TKA围术期老年患者输注37℃血液及液体并在术区使用39℃冲洗液,可有效防止低体温发生,改善苏醒质量及术后认知功能。

Objective To evaluate the clinical effect of different temperature of fluids and blood infusion on postoperative recovery quality in elderly patients undergoing total knee arthroplasty（TKA）.Methods One hundred and fifty-six cases of elderly patients（male 42,female 114,aged 65-85 years,ASA Ⅰ or Ⅱ）scheduled for selective single TKA were recruited and divided into three groups randomly（n=52each）,normal temperature group（group NT）,constant temperature group（group CT）and warming temperature group（group WT）.Patients of group NT were infused with blood or fluids of room temperature（22-24℃）and surgical area were flushed with fluid of room temperature too.Patients of group CT were infused with blood or fluids of 37 ℃ by heating apparatus and temperature of fluids used to flushing was 37℃too.Otherwise,in group WT,the tempreture of blood and fluids for infusion were kept at 37℃and the surgical area were flushed with fluid of 39℃.The nasopharyngeal temperature were recorded on time points of before anesthesia（T0）,30min（T1）and 1h（T2）after surgery beginning,30min（T3）and 1h（T4）after surgery.Time of spontaneous breathing,time of eye opening on call,time of fully conscious,extubation time and Steward scores of patients were recorded too.And the cognitive function were evaluated by Postoperative Quality Recovery Scale（PQRS）on time points of 15 min and 40 min after extubation and the 1,3,30 dafter surgery.Results Compared with T0,the nasopharyngeal temperature of three groups were significantly decreased at T1-T4（P〈0.05 or P〈0.01）.The nasopharyngeal temperature of group CT and group WT were significantly higher than in group NT at T1-T4（P〈0.01）.And the nasopharyngeal temperature of group WT was significantly higher than in group CT at T4（P〈0.05）.Compared with group NT,time of eye opening on call and spontaneous breathing in groups CT and WT were significantly shorter（P〈0.01）.Time of fully conscious in group WT was obviously shorter than in group NT（P〈0.01）,and the Steward score in group WT was significantly higher than in group NT（P〈0.05）.Compared with before extubation,the cognitive function scores in all patients at 15,40 min after extubation and 1,3,30 dafter surgery were increased significantly（P〈0.01）.The cognitive function scores in group CT and group WT at all time points were significantly higher than that in group NT（P〈0.05）.And the cognitive function scores in group WT was significantly higher than that in group CT at 30 dafter surgery（P〈0.05）.Conclusion The elderly patients undergoing TKA receiving blood transfusion and infusion at 37℃and flushing the area with fluid at 39℃can prevent the occurrence of hypothermia and improve the postoperative recovery quality and cognitive function recovery.