围手术期低体温控制对术后PACU出室时间影响的研究

The influence of inadvertent perioperative hypothermia on the time of PACU discharge

目的探讨围手术期低体温控制对术后麻醉恢复室(PACU)出室时间的影响与效果。方法选取2019年6~12月在我院行择期全身麻醉下腰椎手术的患者64例,随机分为观察组(n=32)和对照组(n=32)。对照组患者采取常规保温措施;观察组全程保温,入室后给予温箱加温棉被预保温,并做好心理疏导。术中加温毯保温,输血输液加温仪加温液体。所有患者采用全身麻醉,全身麻醉诱导气管插管时给予顺式阿曲库铵0.15 mg/kg,术中肌肉松弛药经静脉输液泵输注维持,持续监测膀胱温度。术后送入PACU,进行持续肌松监测,顺式阿曲库铵停止输注后15 min抽取血液进行肌松药残留浓度检测。记录患者4个成串电刺激(TOF)比值恢复至90%的时间、苏醒时间、岀室时间。结果与对照组相比,观察组围手术期低体温发生率明显降低(P<0.05)。观察组的肌松恢复时间明显低于对照组(P<0.05)。肌松药残留浓度对照组高于观察组(P<0.05)。苏醒时间、岀室时间观察组明显低于对照组(P<0.05)。结论围手术期进行低体温控制有助于肌肉松弛的恢复,缩短苏醒时间,减少PACU滞留时间,提升手术患者麻醉围手术期安全性。

Objective The study was performed to explore and evaluate the influence of inadvertent perioperative hypothermia on the time of PACU discharge.Methods Sixty-four patients who underwent elective lumbar surgery,from June to December 2019,were randomly allocated to the observation group(n=32)and the control group(n=32).Patients in the control group took conventional heat preservation measures,and patients in the observation group were kept warm for the whole process.After patients entering the PACU,heating apparatus and heating quilts were adopted for pre-insulation.Meanwhile,these patients received psychological guidance.During the operation,heating blankets were used to keep warm and the blood transfusion heater was adopted to heat liquid.All patients were received 0.15 mg/kg cisatracurium during the induction of anesthesia.Bladder temperature monitoring was performed in all patients.In maintenance of anesthesia,cisatracurium was continuously given by intravenous micro-dosage pump to maintain the neuromuscular block.After the surgical procedure,all patients were admitted to the PACU and the neuromuscular monitoring was performed.Blood samples were performed to detect the residual concentration of cisatracurium at 15 min after withdrawal of the infusion.The time to recovery of a train-of-four(TOF)ratio of 0.9,time to recovery from anesthesia and discharge from PACU were recorded.Results Compared with the control group,the incidence of perioperative hypothermia was significantly decreased in the observation group(P<0.05).The time to recovery of TOF ratio of 0.9(P<0.05),time to recovery from anesthesia(P<0.05)and discharge from PACU(P<0.05)were obviously shorter in the observation group.The residual concentration of cisatracurium in the observation group was significantly lower compared with the control group(P<0.05).Conclusion Perioperative controlled hypothermia could significantly shorten the time to recovery of neuromuscular block,time to recovery from anesthesia and the length of PACU.