室温状态的灌洗液在经尿道前列腺电切术围手术期中的应用效果观察

Effect of room temperature irrigating fluid in the perioperative period of transurethral resection of prostate

目的 比较不同灌洗液温度对经尿道前列腺电切（TURP）围手术期患者生命体征的影响.方法 选取2016年6月至2017年6月在临海市第一人民医院进行TURP治疗的患者56例为研究对象,采用随机数字表法将患者分为观察组和对照组各28例.患者均于连续硬膜外麻醉下行TURP.观察组患者灌洗液进行加温,保持在37℃.对照组患者灌洗液未加温,温度约为21℃.观察两组患者手术相关指标是否有明显差异.观察两组患者术前、术中30 min、45 min、60 min平均动脉压（MAP）、心率（HR）、体温（T）、血氧饱和度（SaO2）的变化,并比较两组患者出现低温的情况.结果 两组患者手术时间、灌洗液用量、切除的前列腺组织重量及术中出血量等差异均无统计学意义.术前、术中30 min两组患者MAP、HR、T、SaO2差异无统计学意义（均P〉0.05）,观察组术中45 min、60 min MAP分别为（92.14±8.63）mmHg、（92.06±8.19）mmHg,明显高于对照组的（85.33±9.01）mmHg、（79.26±9.84）mmHg（均P〈0.05）;观察组术中45 min、60 min时HR分别为（79.45±8.64）次/min、（79.50±9.06）次/min,明显高于对照组的（72.47±8.21）次/min、（65.44±7.10）次/min（均P〈0.05）;观察组术中45 min、60 min时T分别为（36.42±0.16）℃ 、（36.12±0.20）℃,明显高于对照组的（36.40±0.14）℃ 、（35.84±0.23）℃（均P〈0.05）,但两组SaO2差异无统计学意义（P〉0.05）.观察组患者总体发生低温3.57％,诱发心律失常患者0.00％,对照组分别为35.71％ 、25.00％,观察组均低于对照组（χ2=7.240,P=0.007;χ2=5.878,P=0.015）;观察组患者超过75岁发生低温5.26％,诱发心律失常患者0.00％,对照组分别为44.44％ 、33.33％,观察组均高于对照组（χ2=4.766,P=0.029;χ2=4.667,P=0.031）.结论 保持在室温状态的灌洗液能够明显改善患者术中的生命体征,减少低温以及由此诱发心律失常情况的发生.

Objective To compare the effects of the different temperature of lavage fluid on the vital signs of the patients during the perioperative period of transurethral resection of prostate （TURP）. Methods From June 2016 to June 2017,56 patients received TURP treatment in the First People＇s Hospital of Linhai were randomly selected. The patients were divided into the observation group and the control group by the random number method, with 28 cases in each group. All patients underwent TURP under continuous epidural anesthesia. The lavage fluid of the observation group was heated and kept at 37℃ . In the control group,the lavage fluid was not heated,the temperature was about 21℃ . The related indicators between the two groups were compared. The changes of 30min,45min and 60min mean arterial pressure （MAP）,heart rate （HP）,body temperature （T） and blood oxygen saturation （SaO2） in the two groups were observed before and during operation,and the hypothermia in two groups was compared. Results There were no statistically significant differences in the operation time,dosage of lavage fluid,weight of the resection of prostate tissue and amount of bleeding during the operation between the two groups（all P 〉 0. 05）. At preoperation and intraoperative 30min,there were no statistically significant differences in MAP,HP,T,SaO2 between the two groups. At intraoperative 45min,60min,MAP levels in the observation group were （92. 14 ± 8. 63） mmHg, （92. 06 ± 8. 19） mmHg,respectively,which were significantly higher than those in the control group [（85. 33 ± 9. 01）mmHg,（79. 26 ± 9. 84）mmHg] （P 0. 05）. The incidence rates of low temperature,induced arrhythmia in the observation group were 3. 57％ ,0. 00％ ,respectively,which were significantly lower than those in the control group （35. 71％ ,25. 00％ ）（χ2 = 7. 240,P = 0. 007;χ2 = 5. 878,P = 0. 015）. The incidence rates of low temperature, induced arrhythmia of patients over 75 years old in the observation group were 5. 26％ ,0. 00％ ,respectively,which were significantly lower than those in the control group（44. 44％ ,33. 33％ ） （χ2 = 4. 766,P = 0. 029,χ2 = 4. 667, P = 0. 031）. Conclusion The irrigating solution maintained at room temperature can significantly improve the vital signs,reduce hypothermia and induced arrhythmia in patients.