围手术期全程复合保温策略对胸腔镜手术患者术后拔管、复苏时间、凝血指标及并发症发生率的影响

Effects of perioperative whole course thermal insulation strategy on extubation,recovery time,coagulation index and the incidence of complications in patients undergoing thoracoscopic surgery

目的:观察围手术期全程复合保温策略对胸腔镜手术患者术后拔管、复苏时间、凝血指标以及并发症发生率的影响。方法:选取浙江省舟山医院2016年10月至2018年2月行胸腔镜手术患者121例,将2016年10月至2017年2月的胸腔镜手术患者59例作为简单保温组,2017年10月至2018年2月的胸腔镜手术患者62例作为全程复合保温组。比较两组受试者术前(T1)、术后24 h(T2)、术后72 h(T3)各时间段内的血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)的变化情况,记录其术后拔管、复苏时间,分析术后寒战、躁动等并发症发生情况。结果:全程复合保温组术后拔管时间及复苏时间均显著短于简单保温组[(8.06±4.60)min比(13.98±7.22)min,(47.19±12.97)min比(56.84±17.49)min](t=5.40、3.47,均P<0.05)。T2、T3时间段内全程复合保温组患者PT、APPT较简单保温组凝血检测结果明显缩短[(12.55±0.88)s比(13.11±0.97)s,(27.44±2.43)s比(29.03±2.14)s;(11.42±0.73)s比(11.87±0.74)s,(27.44±1.96)s比(28.80±2.22)s](t=3.32、3.81,均P<0.05)。全程复合保温组患者术后寒战、躁动发生率显著低于简单保温组患者[7例比27例,5例比22例](χ^(2)=17.782、14.894、3.33、3.57,均P<0.05)。结论:围手术期实施全程复合保温策略可缩短胸腔镜手术患者术后拔管、复苏时间,抑制围手术期凝血功能障碍,降低低体温引起的躁动、寒战等并发症,效果优于简单保温。

Objective To investigate the effects of perioperative whole course thermal insulation strategy on extubation,recovery time,coagulation index and the incidence of complications in patients undergoing thoracoscopic surgery.Methods A total of 121 patients who underwent thoracoscopic surgery who received treatment in Zhoushan Hospital from October 2016 to February 2018 were included in this study.Among them,59 patients who underwent thoracoscopic surgery from October 2016 to February 2017 were included in the simple thermal insulation group,and 62 patients who underwent thoracoscopic surgery from October 2017 to February 2018 were included in the whole process thermal insulation group.Before and 24 hours and 72 hours after surgery,platelet count,prothrombin time,activated partial thromboplastin time and thrombin time were compared between the two groups.Postoperative extubation time and recovery time were recorded.The incidence of shivering,restlessness and other complications was analyzed.Results Postoperative extubation time and recovery time in the whole process thermal insulation group were significantly shorter than those in the simple thermal insulation group[(8.06±4.60)min vs.(13.98±7.22)min,(47.19±12.97)min vs.(56.84±17.49)min,t=5.40,3.47,both P<0.05).At 24 and 72 hours after surgery,platelet count and activated partial prothrombin time in the whole process thermal insulation group were significantly shorter than those in the simple thermal insulation group[(12.55±0.88)s vs.(13.11±0.97)s,(27.44±2.43)s vs.(29.03±2.14)s,(11.42±0.73)s vs.(11.87±0.74)s,(27.44±1.96)s vs.(28.80±2.22)s,t=3.32,3.81,all P<0.05).The incidence of postoperative shivering and restlessness in the whole process thermal insulation group was significantly lower than that in the simple insulation Group(7 cases vs.27 cases,5 cases vs.22 cases,χ^(2)=17.782,14.894,3.33,3.57,all P<0.05).Conclusion Perioperative whole course thermal insulation strategy can shorten extubation and recovery time,inhibit perioperative coagulation dysfunction,and decrease the incidence of perioperative restlessness,shivering and other complications caused by hypothermia.The effect of perioperative whole course thermal insulation is superior to that of simple thermal insulation.