妇科手术围麻醉期体温监测方法探讨

Temperature monitoring methods during perianesthesia in gynecological surgery

目的比较围麻醉期全身麻醉患者两种常用体温监测方法的应用效果,探讨妇科手术中体温监测的选择.方法选择于南京大学医学院附属鼓楼医院行择期妇科手术的35例患者为研究对象,年龄19~72岁,全身麻醉后进行妇科手术.使用飞利浦MX600监护仪201075A温度探头2根,同时进行鼻咽部和腋窝处体温持续监测.麦迪斯顿手麻系统自动记录体温,间隔时间2 min,记录1 h内同一例患者的体温变化.对比同一例患者在全身麻醉后的鼻咽温度和腋窝温度变化.结果腋窝温度上升的速度斜率比为1.5954,鼻咽温度上升斜率比为1.5984,二者比较差异未见统计学意义(P>0.05).并发症发生率:腋窝温度持续监测中鼻黏膜损伤出血0例,并发症发生率为0;鼻咽温度持续监测中出现鼻黏膜损伤出血5例,并发症发生率为14.3%,二者比较差异有统计学意义(χ^2=5.385,P<0.05).鼻咽温度平均值较腋窝温度高0.188℃(36.114℃±0.056℃比35.926℃±0.056℃),差异有统计学意义(P=0.02).鼻咽温度和腋窝温度的变化呈显著正相关(r=0.9808,P<0.01).结论围麻醉期腋窝温度与鼻咽温度上升速度相似,有相同的变化趋势,呈显著正相关,并发症发生率低.围麻醉期腋窝温度监测安全可靠,可以进行持续体温监测.

Objective To compare the application effects of the two methods to monitor temperature during perioperative period of general anesthesia,and to discuss the way of monitoring body temperature during gynecological operation.Methods Thirty-five patients who underwent elective operation after general anesthesia in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,aged 19 to 72 years were selected as the research objects.Two PHILPS MX600 tempemture monitor probes(201075 A)were used to continuously monitor temperature in nasopharynx and armpit.The temperature changes within 1 hour of every patient were recorded by Maddie Houston system automatically,and time interval was 2 min.The changes of nasopharynx and armpit temperalure after general anesthesia in the same patient were compared.Results The rates of temperature rise by the two temperature monitoring methods had no significant difference(P>0.05);the body temperature was 1.5954 in armpit,and 1.5984 in nasophaiyngeal temperature.No patient(0)had hemorrhage of nasal mucosa during temperature monitoring in armpit;however,5 patients(14.3%)had hemorrhage of nasal mucosa during nasopharyngeal temperature monitoring;there was no signified nt difference in the hemorrhage rate(χ^2=5.385,P<0.05).The average temperature of nasophaiynx(36.114℃±0.056℃)was higher than that of armpit temperatur(35.926℃±0.056),and the difference was 0.188℃,which was statistically significant between the two methods(P=0.02).There was a significant positive correlation between nasopharynx temperature and axillary temperature(r=0.9808,P<0.01).Conclusions The perioperative axillaiy temperature is similar to that of nasopharyngeal temperature in the same patient,with the same tendency of change and significant positive correlation.However,the incidence of complication in temperature monitoring in armpit is low.Axillaiy temperature monitoring is safe and reliable,and it can be used for continuous body temperature monitoring in perioperative period.