不同温度的术中冲洗方案对单节段腰椎融合手术患者的生命体征及治疗效果的影响

Influence of temperature-variant intra-operative rinse strategies on vital signs and treatment effect of patients having single segment lumbar vertebra fusion operation

目的:探讨不同温度的术中冲洗方案对行单节段腰椎融合术患者的术中动态生命体征及术后治疗效果的影响。方法:选择2013年7月至2015年6月在平煤神马医疗集团总医院行单节段腰椎融合手术治疗腰椎退行性病变的131例患者并随机分为常规组和低温组,常规组65例仅在创口关闭前应用常温生理盐水进行冲洗,低温组66例采用术中持续低温生理盐水冲洗+创口关闭前应用常温生理盐水进行冲洗;在麻醉后(T_0)、切皮(T_1)、置入椎弓螺钉(T_2)、植骨融合(T_3)、关闭前冲洗(T_4)及关闭后5 min(T_5)收集两组患者在术中的生命体征及术后相关指标。结果:除体温及SPO_2以外,两组术中的MAP,HR及CVP均出现一定程度的波动和变化,与T_0比较,低温组在T_(2~5)的MAP,T_(1~3)的HR,T_(2~4)的CVP均明显升高(P<0.05);常规组在T_(1~5)的MAP,T_(1~2)的HR,T_4的CVP均明显升高(P<0.05);组间比较,低温组在T_(1~5)的MAP、T_4的CVP均明显低于常规组,在T_(2~3)的CVP明显高于常规组(P<0.05)。除术中冲洗量切口感染以外,低温组患者在术中失血量、术后1 d引流量、总住院日及术后VAS评分均明显低于常规组(P<0.05)。结论:术中低温冲洗策略能在一定程度上提升腰椎融合手术患者的术中生命体征稳定性,并能明显减少术中术后创口的出血量、降低术后切口疼痛程度及缩短住院时间。

Objective： To discuss the influence of temperature-variant intra-operative rinse strategies on the vital signs and after-treatment curative effect of the patients who have single segment lumbar vertebra fusion operation. Methods： A total of 131 patients who had single segment lumbar vertebra fusion operation to treat lumbar degeneration in our hospital from July 2013 to June 2015 were selected and randomly divided into a routine group and a low-temperature group. Sixty-five patients of the routine group only adopted normal-temperature saline rinse before wound healing, while 66 patients of the low-temperature group adopted continuous intraoperative saline rinse based on normal-temperature saline rinse before wound healing, The intra-operative vital signs and related postoperative indexes of the two groups after anesthesia （To） and during skin incision （T1）, implantation of vertebral arch fixation system （T2）, bone graft fusion （T3） and rinse before healing （T4） and 5 min after healing （T5） were collected. Results： Except for body temperature and SPO2, intra-operative MAP, HR and CVP of the two groups had certain fluctuations and changes. MAP at T2-5, HR at T1-3 and CVP at T2-4 of the low-temperature group were evidently higher than the corresponding values at TO （P〈0.05）. MAP at T1-5, HR at T1-2 and CVP at T4 of the routine group were evidently higher than the corresponding values at TO （P〈0.05）. As to comparison between groups, MAP at T1-5 and CV-P at T4 of the low-temperature group were evidently lower than the corresponding values of the routine group, while CVP at T2-3 was evidently higher than the corresponding value of the routine group. Except for infection of incisional wound, intra-operative blood loss volume, drainage volume on the first day after operation, hospital stay length and post-operation VAS score of the low-temperature group were obviously lower than those of the routine group （P〈0.05）. Conclusion： Intraoperative low-temperature rinse strategies can improve the stability of intra-operative vital signs of the patients who have lumbar vertebra fusion operation to some extent, and can effectively reduce the intra-operative and postoperative wound bleeding volume, postoperative incision pain degree and hospital stay length.