围术期不同保温措施对新生儿复苏质量的影响

Effect of different perioperative temperature management on anesthesia recurrence in neonates

目的比较围术期常规保温措施与综合保温措施对新生儿复苏质量的影响。方法纳入60例骶管阻滞复合全身麻醉下择期手术的足月新生儿,将其分为常规保温措施组(C组30例)和综合保温措施组(I组30例)。记录两组术前、术中及术后的肛温值,同时评估两组低体温发生情况;记录手术时间、麻醉后复苏室(PACU)的复苏时间及拔管后相关并发症的发生情况。结果两组术前肛温值比较差异无统计学意义(P>0.05),术中及术后肛温值I组高于C组(P <0.05)。与术前肛温值比较,两组术中、术后肛温值均降低(P <0.05)。I组围术期未发生低体温,而C组术中、术后均发生轻、中度低体温。两组手术时间比较差异无统计学意义(P>0.05),I组PACU复苏时间短于C组(P <0.05)。两组相关并发症(如舌根后坠、呼吸暂停、低血压)比较,差异无统计学意义(P>0.05),而寒战发生率C组高于I组(P <0.05)。结论骶管阻滞联合全麻手术的新生儿对体温变化极为敏感,围术期需采用综合保温措施来改善新生儿PACU麻醉复苏质量。

Objective To investigate the effect of perioperatively integrated and conventional temperature management on anesthesia recurrence in neonates. Methods Sixty neonates undergoing selective operation under combined caudal-general anesthesia were randomly divided into conventional temperature management group （group C, n = 30） and integrated temperature management group （group I, n = 30）. Rectal temperature was recorded before,during and after operation. Hypothermia incidence was assessed in the two groups. Operation time, awakening time and complications of anesthesia after extubation were also observed. Results Temperature intro- and postsurgery was decreased in all neonates when compared with that prior to operation. Compared with group C, introand post-surgery temperature in group I was increased significantly （P 〈 0.05）. Mild to moderate hypothermia was found during and after operation in group C while so such incidence was identified in group I. No differences in operation time, incidence of associated complications of anesthesia including glossoptosis, apnea and hypotension were observed between the two groups （P 〉 0.05）. However, neonates in group I experienced significant decrease of awakening time and rate of shivering compared with group C （P 〈 0.05）. Conclusion Neonates under combined caudal-general anesthesia are extremely sensitive to temperature; perioperative integrated temperature managementmay be an effective way to improve anesthesia recurrence.