多模式保温对精准肝切除术中低体温发生的影响

Effect of multimodal warming regimen on development of intraoperative hypothermia in patients undergoing precise hepatectomy

目的评价多模式保温对精准肝切除术中低体温发生的影响。方法选择行精准肝切除术患者60例，性别不限，年龄28～64岁，体重44～89kg，ASA分级Ⅰ或Ⅱ级，CHILD肝功能分级A级，采用随机数字表法分为2组（n=30）：对照组（C组）和多模式保温组（M组）。C组仅在身体裸露处加盖床单，术中使用常温冲洗液冲洗腹腔；M组患者入室后即将室温调至25～26℃，并使用医用升温毯对床垫进行预热，术中维持40℃左右，同时使用充气式升温毯覆盖下半身，并维持37～39℃；麻醉前对输注液体进行加温至37℃；术中使用预热至37℃的0．9％氯化钠注射液冲洗切口。记录术中低体温、低血压和呼吸抑制的发生情况；分别于麻醉诱导前、麻醉后1h、术毕和离开PACU前5min时，行血气分析，记录pH值、碱剩余和乳酸水平；记录术中出血量、苏醒时间、PACU停留时间及PACU期间寒颤、躁动及恶心呕吐发生情况。结果与C组比较，M组术中低体温和PACU期间寒颤、躁动及恶心呕吐发生率降低，苏醒时间和PACU停留时间缩短，离开PACU前5min时pH值升高，术毕和离开PACU前5min时碱剩余降低，乳酸水平降低（P〈0．05或0．01）。结论多模式保温可提高精准肝切除术患者麻醉恢复质量，显著降低术中低体温的发生。

Objective To evaluate the effect of muhimodal warming regimen on the development of intraoperative hypothermia in the patients undergoing precise hepatectomy. Methods Sixty patients of both sexes, aged 28-64 yr, weighing 44-89 kg, of American Society of Anesthesiologists physical status I or II （Child-Pugh A） , undergoing precise hepatectomy, were equally and randomly assigned into control group （ group C） and muhi-model warming group （ group M） using a random number table. A bed sheet was covered on the body exposed, and the abdominal cavity was washed using the room-temperature peritoneal lavage fluid in group C. In group M, after admission to the operating room, the room temperature was raised to 25-26 ℃ , the mattress was prewarmed using the medical heating blanket, the temperature was maintained at 40℃ during operation, the lower body was simultaneously covered using the forced-air warming system, and the temperature was maintained at 37-39 ℃ ; the solution used for infusion was warmed to 37℃ before anesthesia; the incisional area was washed with 0.9% sodium chloride injection which was prewarmed to 37℃ during operation. The development of hypothermia, hypotension and respiratory depression was recorded during operation. Before induction of anesthesia, at 1 h after anesthesia, at the end of operation, and at 5 rain before discharge from postanesthesia care unit （PACU） , blood gas analysis was performed, and the pH value, base excess and lactate level were recorded. The intraoperative blood loss, emergence time, duration of PACU stay, and occurrence of shivering, agitation, nausea and vomiting were also recorded. Results Compared with group C, the incidence of intraoperative hypothermia, and shivering, agitation, nausea and vomiting in PACU were significantly decreased, the emergence time and duration of PACU stay were significantly shortened, the pH value was significantly increased at 5 min before discharge from PACU, and the base excess and lactate level were significantly decreased at the end of operation and 5min before discharge from PACU in group M （P〈0.05 or 0.01）. Conclusion Muhimodal warming regimen can raise the quality of recovery from anesthesia and decrease the development of intraoperarive hypothermia in the patients undergoing precise hepatectomy.