体温保护在老年患者人工全膝关节置换术后快速康复中的应用效果

Efficacy of body temperature protection in rapid recovery after total knee arthroplasty in elderly patients

背景:老年患者人工全膝关节置换术常并发术中低体温,后者是影响患者快速康复的重要因素。目的:评价体温保护在老年患者人工全膝关节置换术后快速康复应用中的效果。方法:选取全身麻醉下行人工全膝关节置换术患者40例,性别不限,年龄大于60岁,BMI 18.0~24.0 kg/m^2,ASA分级Ⅱ级或Ⅲ级,MMSE评分>24分,采用随机数字表法分为两组:常规保温组(n=20)和体温保护组(n=20)。常规保温组采用普通套被行覆盖式保温,体温保护组采用升温毯处理,温度调至37℃~41℃,术中监测患者鼻咽温。两组患者输血输液均经过温箱升温至37℃,术中采用温水冲洗。维持室温22℃~24℃,相对湿度50%。于入室时(T0)、手术1 h(T1)和术毕时(T2)记录两组患者鼻咽温。记录两组患者手术时间、出血量、苏醒时间,苏醒延迟、术后躁动、寒颤、术后恶心呕吐(PONV)及术后谵妄(POD)的发生情况。结果:与T0时比较,常规保温组T1和T2时鼻咽温降低(P<0.01)。与常规保温组比较,体温保护组T1和T2时鼻咽温升高(P<0.05);烦躁、苏醒延迟、PONV和POD的发生例数降低(P<0.05);出血量、PACU停留时间及住院日减少(P<0.05)。结论:体温保护可降低老年患者人工全膝关节置换术后并发症,促进快速康复。

Background:Hypothermia often occurs in total knee arthroplasty in elderly patients,and is an important factor affecting the rapid recovery of the patients.Objective:To investigate the effect of body temperature protection on the rapid recovery in elderly patients after total knee arthroplasty.Methods:Forty patients of both sexes undergoing total knee arthroplasty,older than 60 years,ASA grade Ⅱ or Ⅲ,BMI 18.0 to 24.0 kg/m^2,with normal preoperative temperature,were enrolled.They were divided into 2 groups (n=20) using a random number table:conventional body temperature protection group covering with a common cover and temperature protection group protected by an air-filled insulation machine with the temperature adjusted to 37℃-41℃.The nasopharyngeal temperature was recorded.Both groups used a warming instrument for venous channel warming and the temperature was set at 37℃.Intraoperative irrigation used warm water.Room temperature was set at 22℃-24℃,relative humidity 50%.Nasopharyngeal temperature was recorded at admission to the operating room (T0),1 h after the beginning of the operation (T1) and at the end of operation (T2).The operation time,blood loss,recovery time,and complications as delayed awakening,postoperative agitation,postoperative shivering,postoperative nausea and vomiting(PONV)and postoperative delirium (POD) were recorded.Results:Compared with T0,nasopharyngeal temperature decreased in conventional body temperature protection group at T1and T2(P<0.01);Compared with conventional body temperature protection group,nasopharyngeal temperature increased at T1and T2;the incidence of postoperative agitation,delayed recovery,PONV and POD decreased;the volume of blood loss,the time of PACU stay and hospitalization days decreased in temperature protection group(P<0.05).Conclusions:Temperature protection can reduce the postoperative complications of total knee arthroplasty in elderly patients and promote rapid recovery.