多模式保温对腹腔镜辅助下胃癌根治术老年患者围术期体温和恢复情况的影响

Effect of multimodal warming regimen on development of intraoperative hypothermia in elderly patients undergoing laparoscopic radical gastrectomy

目的探讨全程多模式保温对腹腔镜辅助下胃癌根治术老年患者围手术期体温和恢复情况的影响。方法选择行腹腔镜辅助下胃癌根治术患者55例,性别不限,年龄≥60岁,体质量44~89 kg,ASA分级Ⅰ~Ⅲ级。采用随机数字表法分为两组:多模式保温组(M组,n=28)和对照组(C组,n=27)。M组患者入室前30 min使用医用升温毯40℃对床垫进行预热,术中使用充气式升温毯覆盖下半身,并维持37~39℃,入麻醉恢复室(PACU)后继续使用充气式升温毯;对输注液体进行加温至37℃。C组仅在身体裸露处加盖床单,术中使用常温输液;两组术中均使用预热至37℃的腹腔冲洗液。记录患者入室、麻醉后30 min、麻醉后60 min、术毕、入PACU10 min和离开PACU时核心温度;统计术中输注量、冲洗液量、出血量、尿量、术毕低体温、拔管时间、PACU停留时间及PACU期间寒战、躁动发生情况。结果与C组比较,M组术中低体温和PACU期间寒战及躁动发生率降低,拔管时间和PACU停留时间缩短(P<0.05)。结论全程多模式保温可提高腹腔镜辅助下胃癌根治术患者麻醉恢复质量,显著降低老年患者低体温的发生。

Objective To discuss the influence of whole-course muhimodal warming regimen on perioperative core temperature and recovery in elderly patients undergoing laparoscopic radical gastrectomy.Methods Fifty-five patients of both sexes,aged≥60 yr,weighing 44-89 kg,of American Society of Anesthesiologists physical statusⅠ-Ⅲ,undergoing laparoscopic radical gastrectomy,were equally and randomly assigned into control group(group C,n=27)and multi-model warming group(group M,n=28)using a random number table.In group M,the mattress was prewarmed using the medical heating blanket 30 min before entering,the temperature was main—tained at 40℃,the lower body was simultaneously covered using the forced-air warming system,and the temperature was maintained at 37-39℃,and then continue to use the forced-air warming system in the postanesthesia care unit(PACU);the fluid used for infusion was warmed to 37℃.In group C,a bed sheet was covered on the body exposed,and the fluid was infused using the room-temperature.And the abdominal cavity was washed using the 37℃peritoneal lavage fluid in two groups.The tympanic membrane temperatures were recorded among two groups at the time enter the operation room,30 min and 60 min after anesthesia,the end of operation,10 min in and out of PACU.The intraoperative infusion volume,flushing fluid volume,blood loss,urine volume,extubation time,duration of PACU stay,and occurrence of hypothermia,shivering and agitation were also recorded.Results Compared with group C,group M had a slower temperatureth decreased,and the encidence of intraoperative hypothermia,and shivering and agitation in PACU were significantly decreased,the extubation time and duration of PACU stay were significantly shortened(P<0.05).Conclusion Whole-course muhimodal warming can raise the quality of recovery from anesthesia and decrease the development of intraoperative hypothermia in the elderly patients undergoing laparoscopic radical gastrectomy.