术中加温输液对中老年结直肠肿瘤手术患者术后恢复质量的影响

Effect of intraoperative warming infusion on postoperative recovery quality in elderly patients undergoing colorectal cancer surgery

目的:观察不同输液温度对中老年结直肠肿瘤手术患者术后恢复质量的影响。方法:择期全麻下行开腹结直肠肿瘤手术患者60例,ASA II-III级,随机分为两组,加温组(n=30),利用加温输液仪使输液温度加温至41℃,对照组(n=30),输入在室温(22℃~25℃)下放置的液体,不经加温处理,观察两组患者围术期体温变化,采用术后恢复质量量表(PQRS)评估拔管后15、40 min,术后1、3、7天患者生理功能、焦虑、抑郁、疼痛、呕吐、日常生活活动能力以及认知功能的恢复或发生情况,记录两组患者自主呼吸恢复时间、睁眼时间、意识恢复时间和拔管时间、Steward评分以及苏醒室停留时间。结果:加温组在手术开始后90 min、拔管时、拔管后15 min、40 min鼻咽温明显高于对照组(P<0.05),加温组在拔管时、拔管后15 min的低体温发生率明显低于对照组(P<0.05)。加温组的自主呼吸恢复时间、睁眼时间、意识恢复时间、拔管时间以及苏醒室停留时间均短于对照组,加温组的Steward评分高于对照组(P<0.05),加温组患者在术后15 min、40 min时疼痛发生率较低,任何时点两组患者生理功能恢复率、恶心呕吐发生率、焦虑及抑郁发生率、日常生活活动能力以及认知功能的恢复率差异无统计学意义(P>0.05)。结论:术中加温输液能够很好的预防中老年开腹结直肠肿瘤手术患者围术期低体温的发生,缩短苏醒时间,提高苏醒质量,降低苏醒期疼痛的发生,但对患者生理功能、恶心呕吐、焦虑和抑郁、日常生活能力以及认知功能的发生或恢复没有影响。

Objective： To evaluate the effect of different temperature of fluids on the quality of postoperative recov-ery in elderly patients undergoing colorectal cancer surgery. Methods： 60 patients with elective open colorectal surgery under general anesthesia,ASA Ⅱ-Ⅲ ,were recruited and randomly divided into warming infusion group （n =30）, which were infused with fluids of 41 heating apparatus, and control group （n =30） , which were infused of roomtemperature （22℃∽25℃ ） , without special intervention. We observed the perioperative temperature changes andused PQRS scale （post - operative quality recovery scale） to evaluate the recover of physiology,cognitive function,ac-tivities of daily living,and the occurrence of anxiety,depression,pain,vomiting between two groups at 15 min and 40 min after extubation and the 1,3,7 day after surgery. Time of spontaneous breathing,time of eye opening on call,time of fully conscious, extubation time and steward score and the post - anesthesia care unit residence time were recorded too. Results ： Compared with control group, warming infusion group had higher temperature at 90 min after began of surgery,extubation time,15 min,40 min after extubation（P 〈0. 05） . Hypothermia incidence was significantly lower at extubation time, 15 min after extubation in warming infusion group（P 〈0.05）. Compared with control group,time of spontaneous breathing,time of eye opening on call,time of fully conscious,extubation time and post - anesthesia care unit residence time in warming infusion group were significantly shorter, the Steward score were higher（P 〈 0. 05 ）.The occur of pain at 15 min,40 min after operation was lower in warming infusion group （P 〈 0 .0 5 ） . There was no significant different of physiological function,nausea and vomiting,anxiety,depression and activities of daily living and cognitive function recovery between two groups at any times （P 〉0. 05）. Conclusion ： In elderly patients undergoing colorectal cancer surgery, intraoperative warming infusion can prevent the occurrence of hypothermia, and improve the postoperative recover quality and reduce the occurrence of pain in the recovery period. But it has no influence in the physiological function, nausea and vomiting, anxiety and depression, activities of daily living and cognitive function.