膀胱与鼻咽温度监测在开颅手术中的应用

The application of bladder temperature and nasopharyngeal temperature monitoring in craniotomy

目的观察监测膀胱温度(bladder temperature,BT)与鼻咽温度(nasopharyngeal temperature,NT)在开颅手术中的应用,评估两者的差异性与相关性。方法全麻下行开颅手术50例(ASA分级Ⅰ~Ⅱ级),麻醉期间监测BT和NT,记录麻醉诱导后10分钟(T0),手术开始即刻(T1),手术开始后20分钟(T2)、40分钟(T3)、60分钟(T4)、80分钟(T5)、100分钟(T6)、120分钟(T7)、140分钟(T8)、160分钟(T9)、180分钟(T10)、200分钟(T11)、220分钟(T12)、240分钟(T13)和手术结束时(T14)的BT和NT,记录相关并发症发生情况。结果总体BT比NT高(0.40±0.21)℃,差异有统计学意义(P<0.01),但两者一致性较好。BT与NT体温<36℃的发生率,NT高于BT(P<0.05)。BT与NT高度相关,相关系数r=0.93,直线方程为:Y=0.943X+2.449(Y为BT,X为NT)。NT监测致3例(约6%)病人鼻黏膜出血。结论BT与NT监测均能较好反映开颅病人麻醉期间体温变化,但NT可能反应更为迅速,而BT可能更接近核心体温,且获得方便。

Objective To investigate the effective of bladder temperature(BT)and nasopharyngeal temperature(NT)monitoring in craniotomy,and to assess the differences and correlations between the two temperature monitoring methods.Methods Fifty patients(ASAⅠ~Ⅱ)with general anesthesia and undergoing craniotomy were selected.BT and NT were monitored during anesthesia,and temperature were recorded at the following time points:10 min(T0)after anesthesia induction,immediately at the beginning of the operation(T1),20 min(T2),40 min(T3),60 min(T4),80 min(T5),100 min(T6),120 min(T7),140 min(T8),160 min(T9),180 min(T10),200 min(T11),220 min(T12),240 min(T13)after surgical incision and at the end of the surgery(T14),the related complications were recorded simultaneously.Results The overall BT was(0.40±0.21)℃higher than that of NT,and the difference was statistically significant(P<0.01),but the consistency was better.The incidence of NT below 36℃was significantly higher than that of BT(P<0.05).The temperature of the two different parts was highly correlated,and the correlation coefficient was r=0.93,the linear equation is:Y=0.943X+2.449(Y is bladder temperature and X is nasopharyngeal temperature).Three patients(about 6%)with NT monitoring developed nasal mucosal hemorrhage after surgery.Conclusion Both BT and NT monitoring can reflect the changes of body temperature during craniotomy,but NT may respond more quickly,and the BT may be closer to the core body temperature and be convenient.