综合保温保护对妇科恶性肿瘤患者术后谵妄的影响

Effects of comprehensive body temperature protection measures on postoperative delirium in patients with gynecological malignancies

目的探讨综合体温保护对妇科恶性肿瘤患者术后谵妄发生情况的影响.方法选择2018年2月至2019年2月就诊于江苏省肿瘤医院妇瘤科择期行手术治疗的妇科恶性肿瘤患者60例,年龄65~75岁,平均(68.0±6.8)岁,随机分为综合体温保护组(T组)和对照组(C组),每组30例.C组采用常规术中保温措施;T组在C组基础上,采用充气式升温毯、输入加温液体等综合保温措施.测量两组患者在麻醉开始时(T0),手术开始30 min(T1)、60 min(T2)、90 min(T3)、120 min(T4)以及手术结束时(T5)的鼻咽温度;记录两组患者手术时间、麻醉时间,术中输液量、出血量、冲洗液量、尿量等术中情况,苏醒时间、拔管时间、麻醉后监测治疗室(PACU)停留时间等术后恢复情况,以及寒战、苏醒期躁动、术后72 h内谵妄等并发症的发生情况.结果与T0相比较,C组于T2~T5时鼻咽温度均显著降低(P<0.05);T组患者于T2~T5时鼻咽温度明显高于C组,两组差异有统计学意义(P<0.05).T组手术时间、麻醉时间、术中输液量、出血量、冲洗液量和尿量与C组差异均无统计学意义(P>0.05),而苏醒时间、拔管时间、PACU时间较C组明显缩短(P<0.05).T组患者术后寒战、躁动和谵妄的发生率分别为0、3.3%、3.3%,均明显低于C组的23.3%、20.0%、16.7%(P<0.05).结论采取综合性体温保护措施可以有效降低妇科恶性肿瘤手术患者术后谵妄等的发生率.

Objective To investigate the effect of comprehensive temperature protection on postoperative delirium in patients with gynecological malignant tumor. Methods A total of 60 cases of 65-75 years elderly(Average age: 68.0±6.8) patients undergoing selective operation(2018.2-2019.2)for gynecologic malignant tumor were randomly divided into two groups(n=30): control group(group C) and temperature protection group(group T). Thermal insulation in routine operation were adopted in group C. Inflatable heating blanket, input heating liquid and other comprehensive insulation was employed besides above measures in group T. The nasopharyngeal temperature was recorded at the beginning of anesthesia(T0), 30 min at the beginning of surgery(T1), 60 min at the beginning of surgery(T2), 90 min at the beginning of surgery(T3), 120 min at the beginning of surgery(T4), and at the end of surgery(T5). The operation time, anesthesia time, intraoperative infusion volume, blood loss volume, washout volume and urine volume of the two groups were recorded. The waking time, extubation time, PACU residence time, and the incidence of chills and agitation in the waking period were recorded in the two groups. The incidence of delirium within 72 h after surgery was recorded in both groups. Results Compared with T0, the nasopharyngeal temperature in group C at T2-T5 time points was significantly decreased(P<0.05), the nasopharyngeal temperature in group T at T2-T5 time points was obviously higher than those of in group C(P<0.05). The waking time, extubation time and PACU residence time in group T were significantly lower than those in group C(P<0.05). The incidence of postoperative chills, agitation and delirium in group T(0%, 3.3%, 3.3% respectively) were significantly lower than those in group C(23.3%, 20.0%, 20.0% respectively)(P<0.05). Conclusions Comprehensive temperature protection can effectively reduce the incidence of postoperative delirium in patients with gynecological malignant tumor surgery.