结构化低体温干预方案在老年肠癌衰弱患者术中的应用

Application of structured hypothermia intervention program in elderly intestinal cancer patients with frailty

目的探讨结构化低体温干预方案在老年肠癌衰弱患者术中的应用效果。方法采取整群抽样的方法,选择湖南师范大学第一附属医院湖南省人民医院2017年11月—2018年7月术前老年衰弱评估Fried衰弱评分大于2分的全麻肠癌手术患者96例,应用随机数字表法将患者分为试验组(n=48)和对照组(n=48)。试验组应用结构化管理模式,制订并实施结构化的低体温干预方案;对照组按照护理常规进行保暖护理。比较两组术前、术中及术后的呼吸、血压、心率、血氧饱和度,术中各时间点的体温、低体温发生率及相关指标(拔管时间、复苏室停留时间、尿量、术中出血量)。采用重复测量方差分析、t检验和χ^2检验进行结果分析。结果两组患者体温、血压、心率、呼吸、血氧饱和度均存在时间和组间的交互作用(P<0.05),且试验组随时间的波动均小于对照组。试验组术中低体温发生率低于对照组,拔管时间短于对照组,复苏室停留时间短于对照组,术中出血量比对照组少,尿量较对照组多,差异均有统计学意义(P<0.01)。结论老年肠癌衰弱患者应用结构化低体温干预方案能有效维持术中生命体征平稳、缩短麻醉复苏时间、降低低体温及相关并发症的发生,规范老年肠癌衰弱患者术中低体温预防措施,保障患者术中安全。

Objective To explore the effects of structured hypothermia intervention program in elderly intestinal cancer patients with frailty.MethodsFrom November 2017 to July 2018,we selected 96 patients with surgery for intestinal cancer scored more than two points in Fried frailty assessment for the aged before surgery at the First Affiliated Hospital of Hu'nan Normal University&People's Hospital of Hu'nan Province by cluster sampling.All of the patients were divided into experimental group(n=48)and control group(n=48)with the method of random number table.Experimental group carried out the structured management model,formulated and implemented the structured hypothermia intervention program,while control group provided warm nursing based on nursing routine.We compared the respiration,blood pressure,heart rate and blood oxygen saturation before,during and after surgery as well as temperature,incidence of hypothermia and related indicators(extubation time,retention time in resuscitation room,urine volume and intraoperative blood loss)at each time points during surgery.Results were analyzed with the repeated measure variance analysis,t test andχ2 test.ResultsThere were interactions between time and groups in temperature,blood pressure,heart rate,respiration and blood oxygen saturation(P<0.05).The fluctuation with time of the above vital signs in the experimental group was lower than that of control group.In experimental group,the incidence of hypothermia was lower than that in control group;the extubation time and retention time in resuscitation room were shorter than those in control group;the intraoperative blood loss was less than that in control group and the urine volume was more than that in control group;the differences were all statistically significant(P<0.01).ConclusionsThe application of structured hypothermia intervention program in elderly intestinal cancer patients with frailty can effectively maintain the stable intraoperative vital signs,shorten the time anesthesia resuscitation,reduce the incidences of hypothermia and related complications,standardize preventive measures for intraoperative hypothermia and guarantee patient intraoperative safety among elderly intestinal cancer patients with frailty.