术中保温对老年病人全麻苏醒时间及苏醒期丙泊酚效应室浓度的影响

Effects of intraoperative heat preservation on awakening time of general anesthesia and effect-site concentration of propofol in recovery period of elderly patients

目的分析讨论术中保温对老年病人全麻苏醒时间及苏醒期丙泊酚效应室浓度的影响,以期为临床提供指导性依据。方法选取全麻下行开腹胃肠外科手术的老年病人78例为研究对象,年龄均为60岁以上,参照双盲随机法将病人分为对照组与研究组,每组39例。对照组仅予以液体输入与铺巾覆盖,研究组则采取液体输入、腹腔冲洗液体加温以及暖风毯覆盖等术中保温措施,记录比较两组病人从麻醉开始到手术完成不同时间点的食管温度、平均动脉压(MAP)及丙泊酚效应室浓度的动态变化,偏相关分析MAP、丙泊酚效应室浓度与食管温度的相关性,同时比较两组病人苏醒时间与效应室浓度。结果两组病人在T_0、T_1的食管温度方面差异无统计学意义(P>0.05),研究组T_2~T_6的食管温度均明显高于对照组,差异有统计学意义(P<0.05),另两组不同时间点的MAP均差异无统计学意义(P>0.05)。研究组与对照组T_0~T_5丙泊酚效应室浓度比较差异无统计学意义(P>0.05),研究组T_6丙泊酚效应室浓度高于对照组,差异有统计学意义(P<0.05);MAP与食管温度偏回归系数0.074,两者无明显相关性。丙泊酚效应室浓度与食管温度偏回归系数0.109,两者有较弱的正相关关系,即食管温度越高,则丙泊酚效应室浓度越高;两组病人丙泊酚停药时脑电双频指数(BIS)差异无统计学意义(P>0.05),而在停药时BIS值≥80的恢复时间及其效应室浓度则差异有统计学意义(P<0.05)。研究组睁眼、应答及拔管时间均显著低于对照组(P<0.05)。结论行全麻开腹手术治疗的老年病人实施术中保温有助于维持病人全麻下正常体温,缩短术后苏醒时间,加快病人术后苏醒,临床应用价值较高。

Objective To analyze and discuss the effects of intraoperative heat preservation on awakening time of general anesthesia and effect-site concentration of propofol in recovery period of elderly patients and to provide guidance for clinical treatment. Methods Sev-enty-eight elderly patients who underwent open gastrointestinal surgery under general anesthesia in our hospital were selected as study subjects,aged over 60 years old. Referring to the double blind random method, they were divided into control group and study group, with 39 cases in each. The control group was only treated with liquid infusion and draping while the study group was treated with liquid infusion, heating peritoneal flushing fluid, coverage of heating blanket and other intraoperative heat preservation measures. The changes of esophageal temperature, mean arterial pressure （MAP） and effect-site concentration of propofol at different time points from the start of anesthesia to the end of operation were recorded and compared between the two groups. Correlation analysis of MAP,propofol concen-tration and esophageal temperature by partial correlation analysis. The recovery time and effect-site concentration were compared be-tween the two groups. Results There were no significant differences in the esophageal temperature between the two groups at T0 and T l （P 〉0.05） . The esophageal temperature of study group in T2-T6 was significantly higher than that of control group （P 〈0. 05 ） . There was no significant difference in MAP between the two groups at different time points （P 〉 0 .0 5 ） . There was no significant difference in effect-site concentration of propofol between study group and control group in T0-T5（P 〉0. 05）. The concentration in study group was higher than that in control group at T6 （ P 〈 0. 05 ）. There was no significant correlation between MAP and esophageal temperature partial regression coefficient （0. 074）. There was a positive correlation between the concentration of propofol and the partial regression coeffi-cient of esophageal temperature in 0. 109. Namely,the higher esophageal temperature was,the higher effect-site concentration of propofolwas. There was no significant difference in BIS value （P 〈 0. 05 ） while there were significant differences in recovery time of BIS ^80 and its effect-site concentration between the two groups when drug withdrawal （P 〈0. 0 5 ） . Eyes open and response and extubation time in study group were significantly lower than in control group （P 〈 0. 05 ） . Conclusion The implementation of heat preservation in eld-erly patients during open gastrointestinal surgery under general anesthesia is helpful to maintain the normal body temperature, shorten postoperative recovery time and accelerate the recovery of patients from anesthesia. The clinical application value is high.