手术室复合保温策略对剖宫产极低出生体重儿体温的影响

Effect of operation room compound insulation measure on hypothermia of cesarean section of very low birth weight infants

目的探讨手术室复合保温策略对剖宫产极低出生体重儿低体温的预防效果。方法选取2018年1月至2020年10月在广西壮族自治区人民医院剖宫产分娩、并转入新生儿重症监护室(NICU)的96例极低出生体重儿(VLBWI)作为研究对象。按照入组时间分为对照组和观察组,每组48例。对照组采用常规保暖措施,观察组实施手术室复合保温策略。比较2组VLBWI出生时、出生10 min、进入转运暖箱前的体温、心率、血氧饱和度(SpO_(2))、呼气末二氧化碳分压(PETCO_(2)),并比较入NICU时2组早产儿低体温、低血糖、低氧血症发生率。结果出生10 min、进入转运暖箱前,观察组VLBWI体温、SpO_(2)、PETCO_(2)分别为(36.58±0.49)℃、0.95±0.02、(37.17±3.15)mmHg(1 mmHg=0.133 kPa)和(36.50±0.55)℃、0.94±0.02、(38.08±3.85)mmHg,明显高于对照组的(36.27±0.57)℃、0.93±0.02、(35.85±3.14)mmHg和(35.75±0.48)℃、0.93±0.01、(36.63±3.17)mmHg,差异有统计学意义(t值为2.03~7.13,均P<0.05);进入转运暖箱前,观察组早产儿心率为(140.25±8.67)次/min,明显低于对照组的(145.89±9.23)次/min,差异有统计学意义(t=3.09,P<0.05)。入NICU时,观察组早产儿低体温、低血糖和低氧血症发生率分别为16.7%(8/48)、8.3%(4/48)和12.5%(6/48),明显低于对照组的37.5%(18/48)、22.9%(11/48)和29.2%(14/48),差异有统计学意义(χ^(2)=5.28、3.87、4.04,均P<0.05)。结论基于指南和循证的手术室复合保温策略可有效维持VLBWI体温恒定,减少不良反应发生率。

Objective To investigate the effects of compound insulation measure in operation room on hypothermia of cesarean section of very low birth weight infant(VLBWI).Methods A total of 96 VLBWI,who were born with cesarean section in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2018 to October 2020 and admitted to the neonatal intensive care unit were enrolled in the present study.They were assigned to observation group and control group according to the enrolled time,each group was 48 cases.The control group received routine protocol,the observation group implemented the compound insulation measures.The body temperature,heart rate,blood oxygen saturation(SpO_(2)),end tidal carbon dioxide partial pressure(PETCO2)were measured at birth,10 min after birth and before entering the transfer incubator.The incidence of hypothermia,hypoglycemia and hypoxemia in premature infants were compared between the two groups.Results At 10 min after birth and before entering the transfer incubator,the body temperature,SpO_(2),PETCO_(2) were(36.58±0.49)℃,0.95±0.02,(37.17±3.15)mmHg(1 mmHg=0.133 kPa)and(36.50±0.55)℃,0.94±0.02,(38.08±3.85)mmHg in the observation group,which were significantly higher than those in the control group(36.27±0.57)℃,0.93±0.02,(35.85±3.14)mmHg and(35.75±0.48)℃,0.93±0.01,(36.63±3.17)mmHg,the differences were statistically significant(t values were 2.03-7.13,all P<0.05).Before entering the transfer incubator,the heart rate was(140.25±8.67)times/min in the observation group,which was significantly lower than that in the control group(145.89±9.23)times/min,the difference was statistically significant(t value was 3.09,P<0.05).The incidence of hypothermia,hypoglycemia and hypoxemia were 16.7%(8/48),8.3%(4/48)and 12.5%(6/48)in the observation group,which were significantly lower than those in the control group 37.5%(18/48),22.9%(11/48)and 29.2%(14/48),the differences were statistically significant(χ^(2)=5.28,3.87,4.04,all P<0.05).Conclusions Evidence-based operation room compound insulation measure can effectively maintain the constant body temperature in VLBWI,reduce the incidence of hypothermia,hypoglycemia and hypoxemia.