综合低体温干预措施对行经皮肾镜钬激光碎石术老年患者围术期稳态的影响

Effect of comprehensive hypothermia intervention in elderly patients undergoing percutaneous nephrolithotomy

目的:探讨综合低体温干预措施对行经皮肾镜钬激光碎石术的老年患者围术期稳态的影响。方法:选择期行经皮肾镜钬激光碎石术的老年患者80例,ASAⅠ~Ⅲ级,按随机数字法分为常规保温措施组(对照组,n=40)与综合低体温干预措施组(观察组,n=40),预防术中低体温发生。记录两组患者不同时间点的体温变化和MAP、HR的波动情况;于不同时间点采集动脉血测定血糖和血乳酸含量;记录麻醉苏醒时间,术后寒战、躁动发生率以及平均住院时间。结果:对照组的体温于麻醉诱导后开始下降,手术开始后30 min达最低值,手术结束时和术后30 min均低于入室前水平,差异有统计学意义(P<0.01),观察组患者各时间点的体温与入室前比较,差异无统计学意义(P>0.05)。与对照组比较,观察组MAP和HR波动平稳,差异有统计学意义(P<0.05)。两组患者动脉血的血糖和血乳酸含量均较术前升高,但对照组升高量大于观察组,差异有统计学意义(P<0.05)。观察组麻醉苏醒时间和平均住院天数少于对照组,差异有统计学意义(P<0.05),术后寒战及躁动发生率小于对照组,差异有统计学意义(P<0.01)。结论:对行经皮肾镜钬激光碎石术的老年患者采取综合低体温干预措施,可有效维持患者围术期体温和生命体征,减轻应激反应,麻醉苏醒时间短,术后寒战和躁动发生率低,住院时间减少。

Objective To dissus the effects of comprehensive hypothermia intervention in elderly patients undergoing percutaneous nephrolithotomy.Method 80 patients,ASA physical statusⅠ~Ⅲ,scheduled for elective percutaneous nephrolithotomy,were divided into the conventional in sulation measures group of 40 cases(control group)and the comprehensive hypothermia intervention group of 40 cases(obsevation group)by random number table method.Temperature changes and fluctuations of MAP and HR at different time points in the two groups were recorded.Arterial blood was collected at different times to measure blood glucose and blood lactic acid content.Anesthesia recovery time,postoperative chills、restlessness,and mean hospital stay were also recorded.Results In control group,the body temperature began to decline after anesthesia induction,reached lowest at 30 min after the operation,and also lower at the end of the operation and 30 min after the operation(P<0.01).There was no significant difference in two groups at each time(P>0.05).Compared with the control group,MAP and HR in observation group were stabled(P<0.05).The blood glucose and blood lactic acid content of arterial blood in both groups were higher than that before surgery,but was higher in control group than in observation group(P<0.05).The anesthesia waking time,the postoperative chills、agitation and the average hospitalization days in observation group were less than those in control group(P<0.05).Conclusion The comprehensive hypothermia intervention in elderly patients undergoing percutaneous nephrolithotomy,can effectively maintain the perioperative body temperature and vital signs,reduce the relieve stress,the anesthesia recovery time,the incidence of postoperative chills and agitation,and the mean hospital stay were reduced.