自制保温袜对老年脊柱手术患者体温保护效果的研究

Effects of in-house made heat preservation socks on body temperature maintenance in elderly patients undergoing spinal surgery

目的观察自制保温袜对老年脊柱手术患者体温的保护效果。方法采用随机对照研究,入选84例择期行脊柱后路手术的老年患者,年龄65~75岁,采用随机数字表法分为试验组和对照组各42例,两组患者采用相同的麻醉方式,对照组实施常规体温管理,试验组则在常规体温管理基础上全程使用自制保温袜,使用一次性体温探头动态监测患者的肛门温度,记录麻醉诱导插管后即刻(T_(0))、手术切皮时(T_(1))、手术开始后1 h(T_(2))、手术开始后2 h(T_(3))、手术结束(T_(4))、入复苏室即刻(T_(5))、气管拔管后即刻(T_(6))以及拔管后1 h(T_(7))时两组患者生命体征及体温变化,记录术中体温低于36℃的发生率及术后拔管时间、术后寒战发生率、术后切口感染率、平均住院日等指标,记录术后C-反应蛋白、降钙素原等炎性感染指标的变化。结果试验组和对照组患者的性别、年龄、身高、体重、体质指数及手术时间比较差异均无统计学意义(均P>0.05)。在T_(2)~T_(7)时间点,试验组体温均高于对照组[T_(2):(36.5±0.5)℃比(36.3±0.3)℃、(36.6±0.6)℃比(36.2±0.4)℃、(36.6±0.6)℃比(36.2±0.4)℃、(36.6±0.6)℃比(36.2±0.4)℃、(36.6±0.6)℃比(36.2±0.4)℃、(36.6±0.5)℃比(36.2±0.3)℃,t=2.229、3.514、3.823、3.790、3.722、4.408,P=0.029、0.001、0.001、0.001、0.001、0.000];对照组患者术中低体温(<36℃)的发生率高于试验组[47.6%(20/42)比21.4%(9/42),χ^(2)=6.372、P=0.012)];试验组术后寒战发生率低于对照组[21.4%(9/42)比59.5%(25/42),χ^(2)=12.649、P<0.001]。两组患者术后切口感染率、平均住院日及术后炎性感染指标的差异均无统计学意义(均P>0.05)。结论自制保温袜对老年脊柱手术患者体温保护效果较好,可降低老年患者低体温及术后寒战的发生率。

Objective To examine the effects of in-house made heat preservation socks on body temperature maintenance in elderly patients undergoing posterior approach spinal surgery.Methods This was a randomized,controlled trial.A total of 84 patients aged 65-75 years treated with posterior approach spinal surgery under general anesthesia were enrolled.Patients were randomly divided into two groups:the experimental group(n=42)and the control group(n=42).The two groups were treated with the same anesthesia procedure.The control group was given routine temperature management,while the experimental group used in-house made heat preservation socks in addition to routine temperature management during the entire surgical process.The anal temperature of patients was dynamically monitored with a disposable body temperature probe,and body temperature,heart rate,mean arterial pressure and oxygen saturation were recorded at the time of anesthesia induction and intubation(T_(0)),skin incision(T_(1)),1 hour into surgery(T_(2)),2 hours into surgery(T_(3)),the end of surgery(T_(4)),arrival at the post-anesthesia care unit(T_(5)),immediately after extubation(T_(6))and 1 hour after extubation(T_(7)).The occurrence of intraoperative body temperature lower than 36℃,postoperative extubation time,incidence of shivering,postoperative incision infection rate and average length of stay were recorded.Changes in C-reactive protein and procalctonin levels were recorded.Results There was no significant difference in sex composition,age,height,weight,body mass index and operative time between the two groups(all P>0.05).From T_(2)to T_(7),the body temperature of the experimental group was higher than that of the control group[T_(2):(36.5±0.5)℃vs.(36.3±0.3)℃,(36.6±0.6)℃vs.(36.2±0.4)℃,(36.6±0.6)℃vs.(36.2±0.4)℃,(36.6±0.6)℃vs.(36.2±0.4)℃,(36.6±0.6)℃vs.(36.2±0.4)℃,(36.6±0.5)℃vs.(36.2±0.3)℃,t=2.229,3.514,3.823,3.790,3.722,4.408,P=0.029,0.001,0.001,0.001,0.001,0.000].The incidence of intraoperative body temperature lower than 36℃in the control group was higher than that in the experimental group(47.6%vs.21.4%,χ^(2)=6.372,P=0.012).The incidence of postoperative shivering in the experimental group was lower than that in the control group(21.4%vs.59.5%,χ^(2)=12.649,P<0.001).There was no significant difference between the two groups in postoperative incision infection rate,average length of stay and postoperative inflammatory infection indicators(all P>0.05).Conclusions For elderly patients undergoing posterior spinal surgery,the in-house made heat preservation socks have favorable effects on body temperature maintenance and help reduce the occurrence of hypothermia and postoperative shivering.