术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响

Effect of intraoperative warming infusion on temperature and coagulation function in patients undergoing robot-assisted laparoscopic radical surgery for bladder cancer

目的探讨术中加温输液对机器人腹腔镜膀胱癌根治术患者体温和凝血功能的影响。方法选取择期行机器人腹腔镜膀胱癌根治术患者60例,年龄18~65岁,ASAⅠ~Ⅲ级,随机分为对照组和加温输液组,每组30例。对照组采用常规保温措施(室温24℃以上、患者身体覆盖棉被、预热腹腔冲洗液、术后采用充气式升温系统复温);加温输液组在常规保温措施的基础上术中持续加温输液,温度设置为41℃。观察患者围术期核心体温(鼻咽温)和PT、APTT、TT、Fib、PLT等凝血指标的变化。结果对照组术中体温进行性下降(最低35℃),除了基础值和术后1h以外的各时间点体温均低于加温输液组,差异有统计学意义(P<0.05);加温输液组术中体温与基础值比较也有下降(P<0.05),但均在36℃以上。对照组APTT的延长时间大于加温输液组(P<0.05)、TT的缩短时间大于加温输液组(P<0.05);PT、Fib、PLT组间比较无统计学差异。结论机器人腹腔镜膀胱癌根治术中采用持续加温输液,可维持患者体温正常,避免低体温引起的凝血功能紊乱。

Objective To investigate the effect of intraoperative warming infusion on temperature and coagulation function in patients undergoing robot-assisted laparoscopic radical surgery for bladder cancer. Methods A total of sixty patients undergoing robot-assisted laparoscopic radical surgery for bladder cancer,aged 18~65 years,ASA between Ⅰ and Ⅲ,were randomly divided into control group and warming infusion group,30 cases in each group.Patients in control group underwent routine temperature preservation measures(room temperatures set above 24℃,patients covered with the quilts,the peritoneal rinse pre-heated before irrigation,and resuscitation of temperature after surgery);based on the same measures as those in control group,patients in warming infusion group performed continuously warming infusion during anesthesia and surgery,setting the temperature at 41℃.The perioperative core body temperature(temperature of nasopharynx)and changes of coagulation parameters such as PT,APTT, TT,Fib,and PLT were recorded.Results Body temperatures of patients in control group decreased progressively to 35℃ at the conclusion of surgery,with significantly different from those of warming infusion group at the points except the baseline value and 1 h after surgery(P<0.05).However,patients in warming infusion group maintained their temperature within a normal range.The prolongation time of APTT in control group was greater than that of warming infusion group(P<0.05),and the shortening time of TT was greater than that of warming infusion group(P<0.05).There was no significant difference between the two groups with respect to PT,Fib and PLT.Conclusion During the robot-assisted laparoscopic radical surgery for bladder cancer,continuously warming infusion can maintain the patient's temperature within a normal range and avoid the coagulation disorder induced by hypothermia,which is worthy of popularization in clinic.