术中综合保温措施对肺移植患者乳酸水平的影响

Effects of comprehensive temperature preserving nursing on the levels of lactic acid in lung transplantation patients

目的探讨综合保温护理措施对肺移植术中患者体温及动脉血乳酸水平的影响.方法选取肺移植患者46例,采用随机数字表法分为试验组和对照组,每组23例.试验组实施综合保温护理措施,对照组采用常规保温措施.记录并比较2组麻醉前(T0)、胸腔打开后肺动脉阻断前(T1)、肺动脉阻断后(T2)、新肺移植期(T3)、新肺动脉开放后(T4)、术毕(T5)的肛温及动脉血乳酸值.结果2组麻醉前的肛温、血乳酸比较差异无统计学意义(t=1.53、0.61,P>0.05).试验组各手术时期的肛温分别为(36.55±0.14)、(36.42±0.16)、(36.33±0.13)、(36.15±0.11)、(36.45±0.10)℃,高于对照组(35.69±0.17)、(35.52±0.19)、(34.61±0.17)、(34.47±0.13)、(34.79±0.18)℃,差异有统计学意义(F=3.24,P<0.01).试验组各手术时期的乳酸水平分别为(1.50±0.10)、(2.97±0.15)、(3.29±0.15)、(2.15±0.10)、(1.87±0.13)mmol/L,低于对照组(2.37±0.10)、(4.07±0.16)、(5.15±0.21)、(4.85±0.15)、(4.72±0.17)mmol/L,差异有统计学意义(F=1.14,P<0.01).试验组各手术时期的肛温与麻醉前比较,差异无统计学意义(F=0.39~1.41,P>0.05),乳酸水平在T2、T3时期高于麻醉前(F=1.33、1.16,P<0.01),在T4、T5时期恢复至麻醉前水平(F=0.59、1.00,P>0.05).对照组各手术时期的肛温均低于麻醉前(F=1.17~2.51,P<0.01),乳酸水平均高于麻醉前(F=0.51~2.25,P<0.01).结论综合保温护理措施更利于肺移植术中体温的维持,有助于组织的灌注和氧合.

Objective To explore the effects of comprehensive temperature preserving nursing on the body temperature and the levels of lactic acid in lung transplantation patients.Methods Totally 46 patients underwent lung transplantation were randomly divided into experimental group and control group,with 23 patients in each group.Comprehensive insulation nursing measures were implemented in the experimental group,and conventional insulation measures were used in the control group.The rectal temperature and arterial blood lactic acid values of the two groups were recorded and compared before anesthesia(T0),after chest opening but before pulmonary artery occlusion(T1),after pulmonary artery occlusion(T2),during new lung transplantation(T3),after pulmonary artery opening(T4)and after surgery(T5).Results There was no statistically significant difference in rectal temperature and blood lactic acid between the two groups before anesthesia(t=1.53,0.61,P>0.05).The rectal temperature of the experimental group were(36.55±0.14),(36.42±0.160),(36.33±0.13),(36.15±0.11),(36.45±0.10)℃,which was higher than that of the control group(35.69±0.17,35.52±0.19,34.61±0.17,34.47±0.13,34.79±0.18)(F=3.24,P<0.01).The lactic acid level of the experimental group were(1.50±0.10),(2.97±0.15),(3.29±0.15),(2.15±0.10),(1.87±0.13)mmol/L,which was lower than that of the control group(2.37±0.10,4.07±0.16,5.15±0.21,4.85±0.15,4.72±0.17)(F=1.14,P<0.01).There was no statistically significant difference in rectal temperature between T0 and all operative stages in experimental group(F=0.39-1.41,P>0.05).The lactate levels of experimental group at T2 and T3 was higher than that before anesthesia(F=1.33,1.16,P<0.01),and recovered to the pre-anesthesia level at T4 and T5(F=0.59,1.00,P>0.05).In the control group,the rectal temperature during each operation period was lower than that before anesthesia(F=1.17-2.51,P<0.01),and the lactic acid level was higher than that before anesthesia(F=0.51-2.25,P<0.01).Conclusion Comprehensive heat preservation nursing measures can maintain the relative stability of body temperature during lung transplantation,which is conducive to tissue perfusion and oxygenation.