椎管内麻醉前预保温对经尿道钬激光碎石患者低体温发生率的影响

Effect of prewarming before intraspinal anesthesia on the incidence of hypothermia in patients undergoing transurethral holmium laser lithotripsy

目的探究椎管内麻醉前预保温对经尿道钬激光碎石(TUHLL)患者低体温发生率的影响。方法前瞻性选取2021年1月至2021年6月徐州医科大学附属医院60例TUHLL手术患者作为研究对象,所有患者均行椎管内麻醉,随机分为观察组(麻醉前预保温干预)与对照组(常规干预)两组,每组30例。对比两组围手术期体温、心率、平均动脉压(MAP)变化情况,记录两组低体温出现时间、麻醉恢复监护室(PACU)时间、住院时间,随访不良反应发生情况。结果术前、手术30 min两组患者体温差异无统计学意义(P>0.05),手术60 min、术毕及术后30 min观察组体温均高于对照组,差异均有统计学意义(P<0.05)。手术30 min、60 min、术毕及术毕30 min,两组患者MAP指标均高于术前,但观察组明显低于对照组,差异均有统计学意义(P<0.05)。手术30 min,两组心率低于术前,差异均有统计学意义(P<0.05),但两组间心率差异无统计学意义(P>0.05);手术60 min、术毕及术毕30 min,两组患者心率指标均明显高于术前,观察组均低于对照组,差异均有统计学意义(P<0.05)。观察组患者低体温持续时间、PACU时间及住院时间明显短于对照组,差异均有统计学意义(P<0.05)。观察组发生低体温、寒战、躁动的比率为3.33%、6.67%、6.67%,明显低于对照组(26.67%、30.00%、26.67%),差异均有统计学意义(P<0.05)。结论椎管内麻醉前预保温处理能减少TUHLL患者低体温的发生,维持围手术期血流动力学稳定,减少躁动及寒战的发生,促进术后恢复,值得临床推广应用。

Objective To investigate the effect of pre-insulation before spinal anesthesia on the incidence of hypothermia in patients with transurethral holmium laser lithotripsy(TUHLL).Methods Sixty patients undergoing TUHLL surgery in the Affiliated Hospital of Xuzhou Medical University from January 2021 to June 2021 were prospectively selected as the study subjects.All patients underwent spinal anesthesia,and were randomly divided into observation group(pre-insulation intervention before anesthesia)and control group(routine intervention),with 30 patients in each group.The changes of perioperative body temperature,heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups.The occurrence time of hypothermia,the time of anesthesia recovery care unit(PACU)and the length of hospital stay were recorded,and the occurrence of adverse reactions were followed up.Results There were no significant differences in body temperature between the two groups before operation and 30 min after operation(P>0.05).The body temperature of the observation group were higher than those of the control group at 60 min after operation,and 30 min after operation,the differences were statistically significant(P<0.05).MAP indexes of patients in both groups were higher than before operation 30 min,60 min,and 30 min after operation,but the observation group was significantly lower than the control group,the differences were statistically significant(P<0.05).HR in both groups was lower at 30 min after surgery than before,the differences were statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).HR in both groups was significantly higher at 60min after surgery,and at 30 min after surgery,while the observation group was lower than the control group,and the difference was statistically significant(P<0.05).The duration of hypothermia,PACU time and hospital stay in observation group were significantly shorter than those in control group,and the differences were statistically significant(P<0.05).The rates of hypothermia,chills and agitation in the observation group were 3.33%,6.67%,6.67%,which were significantly lower than those in the control group(26.67%,30.00%,26.67%),and the differences were statistically significant(P<0.05).Conclusion Prethermal insulation treatment before spinal anesthesia can reduce the occurrence of hypothermia in TUHLL patients,maintain the stability of perioperative hemodynamics,reduce the occurrence of agitation and chills,and promote postoperative recovery,which is worthy of clinical application.