充气温毯加温技术预防老年和年轻患者围术期低体温效果的比较

Comparison of efficacy of active forced-air warming for preventing perioperative hypothermia between the elderly and young patients

目的观察充气温毯加温技术预防老年患者围术期低体温是否与年轻患者具有相同的效果。方法采用前瞻性、随机临床对照研究。选择择期全麻下腹部手术患者40例,根据患者年龄分为老年组和非老年组20例。所有患者自诱导前20~30 min开始向温毯持续吹入经加热的气体直至离开手术室。术中血液制品和腹腔冲洗液温热至37℃,输入液体均保持室温水平。记录入手术室后、诱导前、诱导后每15 min、术毕、出手术室前患者的核心体温。记录术后寒颤发生情况及观察期间出现的不良反应。结果老年组患者入手术室时和诱导30 min后各个时间点的核心体温均低于非老年组患者,差异具有统计学意义(P<0.05)。出手术室前体温与进入时体温比较,老年组患者明显降低(t=2.353,P=0.03),非老年组患者差异无统计学意义(t=0.233,P=0.818)。老年患者组术中低体温发生率40.0%(8例),高于非老年组5.0%(1例),差异有统计学意义(χ^2=7.025,P=0.008)。结论全麻下行腹部手术时,充气温毯加温技术预防老年患者围术期低体温的效果劣于年轻患者。

Objective To observe whether the active forced-air warming has the same efficacy on the prevention of perioperative hypothermia in the elderly as compared with young patients.Methods This was a prospective,randomized,controlled clinical trial.Forty patients scheduled for abdominal surgery under general anesthesia were allocated to two groups:the elderly group and the young group(n=20,each).All patients received active forced-air warming at 20-30 min before induction of anaesthesia till leaving the operation room.Blood products and peritoneal lavage fluids were warmed to 37℃,and other intravenous fluids were at room-temperature.The core temperatures were recorded after entering the operation room(baseline),before induction of anaesthesia,at 15 min intervals after induction of anaesthesia,at the end of surgery and before leaving the operation room.The postoperative shivering and adverse reactions were also recorded.Results The core temperature was lower in elderly patients than in young patients at baseline and at each time points after 30 min of induction of anaesthesia(P<0.05).In elderly patients,the core temperature was significantly lower before leaving operation room than at the baseline(t=2.353,P=0.03),but in young patients,no significant difference was found in the core temperature between at the baseline and before leaving operation room(t=0.233,P=0.818).The incidence of intra-operative hypothermia was higher in elderly patients than in young patients(40.0%or 8/20 vs.5.0%or 1/20,c^2=7.025,P=0.008).Conclusions During abdominal surgery under general anesthesia,active forced-air warming cannot effectively prevent perioperative hypothermia in elderly patients as compared with young patients.