复杂腔镜手术患者浅表大血管保温效果观察

Effectiveness of heating superficial tissues with large blood vessels in complicated laparoscopic surgeries

目的探讨浅表大血管保温维持复杂腔镜手术患者术中核心体温的效果。方法按照时间段将1 626例复杂腔镜手术患者分为对照组728例和干预组898例,在常规综合保温的基础上,术中分别采用全身型保温毯、浅表大血管保温。记录两组入手术室时鼓膜温度(T0)及手术开始时(T1)、术中60min(T2)、120min(T3)、180min(T4)及入复苏室时(T5)各时间点鼻咽部温度,统计两组术中低体温发生率、失血量、皮肤损伤发生率、麻醉拔管时间、麻醉恢复室停留时间、麻醉苏醒期寒战发生率。结果与对照组比较,干预组热损伤发生率显著降低(P<0.01);两组不同时间点体温及其他观察指标比较,差异无统计学意义(均P>0.05)。结论浅表大血管保温与身下全身型保温毯保温效果一致,能有效维持复杂腔镜手术患者术中核心体温,降低皮肤热损伤发生率,从而节约医疗成本。

Objective To observe the effects of heating superficial tissues with large blood vessels on body temperature maintenance during complicated laparoscopic surgeries.Methods A total of 1 626 patients undergoing complicated laparoscopic surgeries were assigned into a control group of 728 and an intervention of 898 according to chronological order.On the basis of routine comprehensive warming approaches,the control group was given forced-air warming blanket,while the intervention group received heating on large-vessel-rich-skin region noninvasively.Tympanic temperature was measured after admission to the operating room（T0）and nasopharyngeal temperature was measured at commencement of the operation（T1）,60 min（T2）,120 min（T3）,180 min（T4）during the operation and at admission to the post-anesthesia care unit（T5）.Incidence of hypoglycemia,blood loss volume,incidence of skin injury,extubation time,length of stay in PACU and incidence of shivering during recovery period were also measured.Results There was significant difference in the incidence of thermal injury of skin（P〈0.01）,whereas no significant differences were found in body temperature and the other parameters（P〉0.05 for all）.Conclusion Heating superficial tissues with large blood vessels is as effective as forced-air warming blanket in maintaining body temperature during complicated laparoscopic surgeries,and it reduces thermal injury of skin and save medical costs.