两种核心体温监测方法在体外循环变温过程中的应用

Comparison of two core temperature monitoring methods during the process of temperature change of cardiopulmonary bypass surgery

目的比较在体外循环手术变温过程中直肠温度与膀胱温度变化的灵敏性,为体外循环手术温度监测提供更稳定可靠的方法。方法将重庆医科大学附属第一医院2016年6~12月开展的体外循环手术150例患者作为观察对象,同时监测在体外循环开始时及降温3 min、5 min、7 min以及复温开始时及复温5 min、10 min、20 min各时刻的鼻咽温、膀胱温和直肠温度,将直肠温和膀胱温做比较,同时再与鼻咽温做比较。结果体外循环开始及复温开始时刻膀胱温和直肠温几乎一致,差异无统计学意义(P>0.05);在降温3 min、5 min、7 min及复温5 min、10 min、20 min各时刻膀胱温分别为(36.258±0.6 685)℃、(35.488±2.141 0)℃、(35.379±1.019 4)℃、(31.142±1.599 2)℃、(31.933±1.758 1)℃、(33.304±1.424 2)℃;而直肠温为(35.138±0.973 9)℃、(34.112±1.105 8)℃、(33.108±1.125 4)℃、(31.388±1.503 4)℃、(32.475±1.798 1)℃、(34.163±1.338 3)℃,差异均具有统计学意义(P<0.05);无论在降温还是复温阶段,直肠温和膀胱温同时和变化灵敏的鼻咽温比较,直肠温与鼻咽温的相关系数更大,直肠温和鼻咽温的差值的均值和标准差均比膀胱温与鼻咽温的差值小,在变温过程中,直肠温比膀胱温变化更快、更灵敏,尤其在降温过程中。结论在体外循环变温过程中,直肠温更准确快速地反映患者的核心体温。

Objective To compare the sensitivity of rectal temperature and bladder temperature change during cardiopulmonary bypass surgery, and to provide a more stable and reliable method for temperature monitoring of extracorporeal circulation. Methods A total of 150 patients of cardiopulmonary bypass（CPB） were performed in our hospital from June to December in 2016. Nasopharyngeal temperature, bladder temperature and rectal temperature were recorded at the beginning of cardiopulmonary bypass, 3 minutes, 5 minutes, 7 minutes of cooling, the beginning of rewarming, and5 minutes, 10 minutes, 20 minutes of rewarming. The rectal temperature and bladder temperature was compared, and then compared with the nasopharyngeal temperature. Results There was no significant difference in bladder temperature and rectal temperature between the beginning of CPB and the beginning of rewarming（P0.05）. The bladder temperature at 3 min, 5 min, 7 min of cooling and for 5 min, 10 min, 20 min of rewarming was respectively（36.258±0.668 5）℃,（35.488±2.141 0）℃,（35.379±1.019 4）℃,（31.142±1.599 2）℃,（31.933±1.758 1）℃,（33.304±1.4242）℃, and the rectal temperature was（35.138±0.973 9）℃,（34.112±1.105 8）℃,（33.108±1.125 4）℃,（31.388±1.503 4）℃,（32.475±1.798 1）℃,（34.163±1.338 3）℃, showing statistically significant difference（P0.05）. The correlation coefficient of rectal temperature and nasopharyngeal temperature was bigger than that of bladder temperature and nasopharyngeal temperature, and the mean and standard deviation of the difference between rectal temperature and nasopharyngeal temperature were smaller than those of bladder temperature and nasopharyngeal temperature. In the process of temperature change, rectal temperature was faster and more sensitive than bladder temperature, especially in the cooling process. Conclusion Rectal temperature can more accurately and rapidly reflect the patients＇ core body temperature during cardiopulmonary bypass.