不同保温方式对骨科手术患者体温变化的影响

Effects of two different warming patterns on body temperature changes in patients undergoing orthopedic surgery

目的 探讨2种不同保温方式对骨科手术患者体温变化的影响.方法 选取全麻骨科手术患者60例,按照随机数字表法分为观察组和对照组各30例,加温毯加温温度均设置为38℃,观察组入室后给予间歇保温模式,即每加温1h后,间歇40min再加温,对照组入室后给予连续保温模式.手术中持续监测患者肛温变化,比较不同保温方式预防低体温的效果.结果 观察组患者麻醉前、手术开始、手术30min、60min、90min、120min、手术结束（皮肤缝合后）、麻醉意识恢复时8个时间点肛温分别为（36.68±0.34）、（36.69±0.41）、（36.60±0.37）、（36.54±0.40）、（36.53±0.49）、（36.50±0.58）、（36.49±0.61）、（36.53±0.52）℃,对照组分别为（36.76±0.43）、（36.64±0.40）、（36.50±0.39）、（36.45±0.41）、（36.51±0.52）、（36.65±0.42）、（36.65±0.44）、（36.69±0.44）℃,2组比较差异无统计学意义（t=-1.332~1.083,P〉0.05）;观察组术后寒战、皮肤损伤发生率及麻醉后意识恢复时间分别为16.67%（5/30）、0（0/30）、（10.13±6.51）min,对照组分别为10.00%（3/30）、10.00%（3/30）、（10.07±7.49）min,2组比较差异无统计学意义（P〉0.05）;观察组术中出汗发生率为0（0/30）,对照组为13.33%（4/30）,术中出汗发生率差异有统计学意义（χ2=4.286,P〈0.05）.结论 采用加温毯间歇保温模式给骨科手术患者保温,可以达到和连续保温同样的预防低体温效果,同时还可以减少患者术中出汗和皮肤损伤的发生,节约医疗成本.

Objective To observe the effects of two different warming patterns on body temperature changes in patients undergoing orthopedic surgery. Methods A total of 60 patients undergoing orthopedic surgery under general anesthesia were randomly divided into the observation group and the control group,with 30 cases in each group.In the observation group,the warming blanket was set at 38℃ in an intermittent warming pattern, i.e. every 1 hour heating period was followed by a 40 min interval.In the control group,the warming blanket was set at 38℃in a continuous warming pattern.Anal temperature was continuously monitored during operation to compare the preventive effects of the two warming patterns on hypothermia. Results Anal temperature changes were recorded at 8 time points including pre-anesthesia, the beginning of operation, 30 min, 60 min, 90 min and 120 min after the beginning of operation, completion of operation （after skin closure） and recovery of consciousness. The observation group were（36.68±0.34）℃,（36.69±0.41）℃,（36.60±0.37）℃,（36.54±0.40 ）℃,（36.53± 0.49） ℃, （36.50 ± 0.58） ℃, （36.49 ± 0.61） ℃, （36.53 ± 0.52） ℃, the control group were （36.76 ± 0.43） ℃, （36.64±0.40）℃,（36.50±0.39）℃,（36.45±0.41）℃,（36.51±0.52）℃,（36.65±0.42）℃,（36.65±0.44）℃, （36.69±0.44）℃.There were no statistical differences in anal temperature at all time points between the two groups （t=-1.332~1.083, P〉0.05）. In addition, the comparison of post-operation shivering, skin injury,recovery time of consciousness post-anesthesia,the observation group were,16.67%（5/30）,0（0/30）, （10.13±6.51）min,the control group were,10.00%（3/30）,10.00%（3/30）,（10.07±7.49）min,there were not significantly difference between two groups（P〉0.05）.However,the incidence of sweating during operation in the control group was higher than that of the observation group （χ2=4.286, P〈0.05）, the observation group was 0（0/30）,the control group was 13.33%（4/30）. Conclusions Application of warming blanket in an intermittent warming pattern showed a similar preventive effect on hypothermia as the continuous warming pattern in patients undergoing orthopedic surgery. Moreover, intermittent warming reduced the incidences of sweating and skin injury during operation,reduce health care costs.