围术期体温保护对行垂直半喉切除手术患者体温和末梢循环及出凝血时间影响

Effects of perioperative thermoregulation on patients' body temperature,peripheral circulation and blood coagulation time in patients undergoing elective vertical hemi-laryngectomy

目的:比较不同保温措施对行垂直半喉切除手术患者围术期体温、末梢循环及出凝血时间的影响。方法:选取择期行垂直半喉切除手术患者60例,随机分为3组:术前气体加温组(A组,20例),术中液体加温组(B组,20例),对照组(C组,20例)。比较各组患者围术期体温,手术结束时血气pH、乳酸及出凝血时间,苏醒后末梢氧和及热舒适度情况。结果:3组患者入手术室、诱导前及术后2h体温差异无统计学意义,手术开始后20min及入术后恢复室体温比较C组明显低于A、B组,A、B组差异无统计学意义,术后血气pH比较3组差异无统计学意义,乳酸、出凝血时间、末梢氧和比较C组与A、B组差异无统计学意义,A、B组差异无统计学意义,术后热舒适度比较3组均差异明显。结论:半喉切除手术术中应用空气加温联合术前空气加温或术中液体加温可有效防治围术期低体温,对患者末梢循环及出凝血时间均有一定改善,提高患者术后舒适度。

Objective：To compare the effects of different thermal insulation measures on perioperative body temperature,peripheral circulation and blood coagulation time in patients undergoing vertical hemi-laryngectomy.Method：Sixty eligible patients with elective vertical hemi-laryngectomy were randomly divided into 3groups：preoperative inflatable heating blanket group（A group,n=20）,warmed irrigation group（B group,n=20）,and control group（C group,n=20）.The core temperature were recorded after entering the operating room,before induction,20 th minute during operation,entering PACU and 2nd hour after operation respectively.Blood samples were got at the end of operation to test pH,lactic acid,PT and APTT.After waking patients＇ SpO2 and thermal comfort were recorded.Result：The core temperatures at time points of 20 th minute during operation and entering PACU were significantly different between C group and A group,C group and B group.There were significant difference in lactic acid,PT,APTT and SpO2 between C group and A group,C group and B group.Patients＇ thermal comfort in all three groups were different.Conclusion：Inflatable heating blanket during operation combined with using it before operation or fluid warmers during operation for perioperative body temperature protection duringelective vertical partial laryngectomy surgery can effectively prevent perioperative hypothermia,improve peripheral circulation and blood coagulation time changes,improve patients＇ comfort after operation.