多模式保温对老年消化道恶性肿瘤术中低体温及麻醉恢复质量影响

The effect of multi-mode heat preservation on the quality of hypothermia during operation and anesthesia recovery in elderly patients with malignant tumor

目的探讨多模式保温举措对老年消化道恶性肿瘤术中低体温及麻醉恢复质量的影响结果。方法选取本院手术室2018年1月至2020年7月行择期消化道恶性肿瘤手术的60岁以上老年患者48例,随机分为对照组(n=24)和观察组(n=24)。对照组术前预调节至正常温湿度状态,术中静脉通道所输入液体及灌洗液均为常温。观察组实施多模式保温举措,包括术前预加温、术中加温处理及术后麻醉苏醒期后续保温措施的实施。对比两组围术期各节点的体温波动,术中应激(循环系统指标心率、收缩压/舒张压)以及术后麻醉苏醒质量。结果两组术前(T1)体温比较无明显差异(P>0.05),其他3个节点体温变化幅度比较差异明显(P<0.05);对照组围术期中手术过程(T3)的循环系统指标心率、收缩压/舒张压的波动幅度明显高于观察组,差异明显(P<0.05);两组麻醉和手术平均时间,术中静脉补液总量、灌洗液量、出血总量和尿量比较均无明显差异(P>0.05),但观察组麻醉后睁眼时间、拔管时间和苏醒室(PACU)留观时间均明显短于对照组(P<0.05)。结论对接受消化道恶性肿瘤手术的老年患者实施围术期多模式保温举措,可明显降低患者围术期不良应激,促进患者生命体征的稳定,保证患者麻醉和手术安全,提高术后麻醉恢复质量。

Objective:To explore the effect of multi-mode insulation measures on the effect of hypothermia during surgery and the quality of anesthesia recovery in elderly patients with malignant gastrointestinal tumors.Methods:A total of 48 elderly patients over 60 years of age who underwent elective gastrointestinal malignant tumor surgery in our hospital's operating room from January 2018 to July 2020 were randomly divided into control group(n=24)and observation group(n=24).In the control group,the operating room was pre-conditioned to normal temperature and humidity before the operation,and the intravenous fluid and lavage fluid input during the operation were at room temperature.The observation group implemented multi-mode insulation measures,including pre-operative pre-warming,intraoperative warming treatment,and implementation of follow-up heat-preservation measures during postoperative anesthesia recovery.The deep monitoring body temperature fluctuations,intraoperative stress(circulatory system index heart rate,systolic/diastolic blood pressure)and the quality of postoperative anesthesia were compared between the two groups during the perioperative period.Results:There was no significant difference in body temperature before operation(T1)between the two groups(P>0.05),while the other three nodes had significant differences in body temperature changes(P<0.05);the control group had circulatory system indicators during the perioperative period(T3),heart rate,the fluctuation range of systolic blood pressure/diastolic blood pressure was significantly higher than that of the observation group,and the difference was significant(P<0.05);the average time of anesthesia and operation in the two groups,the total amount of intravenous fluids,lavage fluid,total bleeding and urine volume were all compared.There was no significant difference(P>0.05),but the eye-opening time,extubation time and staying time in the recovery room(PACU)after anesthesia in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion:Implementing perioperative multi-mode insulation measures for elderly patients undergoing gastrointestinal malignant tumor surgery can significantly reduce perioperative adverse stress of patients,promote the stability of patient vital signs,ensure patient anesthesia and surgical safety,and improve the quality of postoperative anesthesia recovery.