加热措施对腹腔镜手术患者影响的研究

Study on the effect of heating measures on patients undergoing laparoscopic surgery

目的研究术中加热对腹腔镜手术围手术期低温及并发症的影响.方法选取2016年3月至2017年3月入住大连市第五人民医院普外科病房行腹腔镜手术患者共126例,采取完全随机设计的2个总体均数假设检验,利用计算机生成126个随机表,将患者按照随机数字表分为干预组及对照组,每组各63例.对照组患者术中采取被动保温,干预组从离开病房移入手术床至手术前用加热毯覆盖预热,术中给予加热毯覆盖下肢,记录所有患者入院时的人口统计学以及术前、术中、术后的临床数据,并比较2组的差异.结果干预组在麻醉后120、180、240、300、400 min核心温度分别为(35.6±1.3)、(35.7±1.6)、(35.5±1.4)、(35.4±1.3)、(35.7±1.1)℃,对照组分别为(35.0±1.2)、(34.9±1.1)、(34.7±1.1)、(34.4±1.1)、(34.3±1.1)℃,2组比较差异有统计学意义(t=1.23~4.32,P<0.05).干预组术中出血量,术后核心体温恢复至36°C所需要的时间,术后疼痛评分分别为(98.0±52.6)ml,(40.1±28.3)min,(5.1±4.2)分,对照组分别为(167.2±52.6)ml,(98.1±47.3)min,(6.7±4.1)分,2组比较差异有统计学意义(t=2.34、7.87、4.56,P<0.05或0.01).干预组无明显颤抖发生率为65.8%(41/63),心电监测可见颤抖发生率为12.7%(8/63),面颈部可见颤抖发生率为12.7%(8/63),胸腔及躯干可见颤抖发生率为9.5%(6/63),全身颤抖发生率为0;对照组分别为38.1%(24/63)、20.6%(13/63)、15.9%(10/63)、20.6%(13/63),4.8%(3/63).2组比较差异有统计学意义(χ^2=3.45,P<0.05).结论术中加热可提高腹腔镜患者的核心温度,减少出血及并发症.

Objective To study the effect of intraoperative heating on perioperative hypothermia and complications in laparoscopic surgery.Methods A total of 126 patients who underwent endoscopic sinus surgery in the general surgery ward of the Fifth People′s Hospital of Dalian from March 2016 to March 2017 were selected.Two population-average hypothesis tests with completely random design were used to generate 126 random tables by computer.The patients were randomly divided into the intervention group and the control group,with 63 cases in each group.In the control group,passive heat preservation was used during the operation.The intervention group was preheated by heating blanket from the time of leaving the ward to the operation bed,and the heating blanket was used to cover the lower limbs during the operation.The demographics of all patients at admission and preoperation,after surgery were recorded.The statistical differences between the two groups were compared.Results The core temperatures of the intervention group 120,180,240,300,and 400 min after anesthesia were(35.6±1.3),(35.7±1.6),(35.5±1.4),(35.4±1.3),and(35.7±1.1)°C,respectively.Those in the control group were(35.0±1.2),(34.9±1.1),(34.7±1.1),(34.4±1.1),and(34.3±1.1)°C,respectively.The difference between the two groups was statistically significant(t=1.23-4.32,P<0.05).The amount of intraoperative blood loss in the intervention group and the time required for the postoperative core body temperature to return to 36°C,pain score after surgery were(98.0±52.6)ml,(40.1±28.3)min,5.1±4.2,and(167.2±52.6)ml,(98.1±47.3)min,6.7±4.1 in the control group.The difference was statistically significant(t=2.34,7.87,4.56,P<0.05 or 0.01).The incidence of no significant tremor was 65.8%(41/63)in the intervention group,12.7%(8/63)in the electrocardiogram,and 12.7%(8/63)in the face and neck.The incidence of visible tremor in the trunk was 9.5%(6/63),and the incidence of systemic tremor was 0.In the control group,they were 38.1%(24/63),20.6%(13/63),and 15.9%(10/63),20.6%(13/63),4.8%(3/63).There were statistical differences between the two groups(χ^2=3.45,P<0.05).Conclusion Intraoperative heating can increase the core temperature of patients undergoing laparoscopic surgery and reduce bleeding and complications.