全程复合保温策略对剖宫产手术并发症、产妇凝血功能及血清炎症指标的影响

Effects of a perioperative whole course composite thermal insulation strategy on complications of cesarean section, maternal coagulation function and serum inflammatory indexes

目的探讨围手术期全程复合保温策略对蛛网膜下腔阻滞剖宫产产妇手术并发症、凝血功能及血清炎症指标的影响。方法选取舟山医院2020年6月至2021年8月收治的剖宫产产妇250例为观察对象,将2020年6-11月的剖宫产产妇125例设为常规简单保温组,2020年12月至2021年8月的剖宫产产妇125例设为全程复合保温组。两组产妇均在蛛网膜下腔阻滞下行剖宫产手术,记录其术中出血量,统计寒战、术后感染等并发症发生率。对比两组产妇术前(T1)、术后48 h(T2)的血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)的变化情况;分析术后48 h两组产妇外周血白细胞计数(WBC)、中性粒细胞百分比(N%)、C反应蛋白(CRP)、降钙素(PCT)、白细胞介素6(IL-6)的差异。结果全程复合保温组产妇术中出血量[(393.84±79.78)mL]显著少于常规简单保温组[(434.80±123.49)mL](t=3.11,P<0.05);寒战[10.4%(13/125)]、术后感染[7.2%(9/125)]等并发症发生率显著低于常规简单保温组[25.6%(32/125)、18.4%(23/125)](χ^(2)=9.78、7.02,均P<0.05);T2时间段内全程复合保温组患者PT[(10.28±0.48)s]、APPT[(26.97±2.27)s]、TT[(14.09±1.36)s]均短于常规简单保温组[(11.71±0.27)s、(27.96±2.25)s、(15.91±1.09)s](t=7.34、3.43、11.66,均P<0.05);全程复合保温组产妇术后48 h WBC[(10.38±2.38)×10^(9)/L]、N%(0.79±0.06)、CRP[(52.79±20.73)mg/L]、PCT[(0.13±0.42)μg/L]及IL-6水平[(55.73±24.38)ng/L]均低于常规简单保温组[(12.24±7.05)×109/L、0.81±0.05、(65.38±25.92)mg/L、(0.20±0.97)μg/L、(76.22±39.08)ng/L](t=2.79、2.92、4.24、8.12、4.97,均P<0.05)。结论围手术期全程复合保温策略可提高蛛网膜下腔阻滞剖宫产产妇凝血功能,减少术中出血量,降低寒战发生率,有效降低炎性反应和术后感染发生率。

Objective To investigate the effects of a perioperative whole course composite thermal insulation strategy on complications of cesarean section,maternal coagulation function and serum inflammatory indexes.Methods A total of 250 pregnant women who were subjected to cesarean section in Zhoushan Hospital between June 2020 and August 2021 were included in this study.The 125 pregnant women who gave birth using a routine simple thermal insulation strategy from June to November 2020 were assigned to the routine simple thermal insulation group,and those who gave birth using a perioperative whole course composite thermal insulation strategy were assigned to whole course composite thermal insulation group.Two groups of pregnant women underwent cesarean section under subarachnoid block.Volume of intraoperative blood loss was recorded.The incidence of complications such as shivering and postoperative infection was calculated.Platelet count,prothrombin time,activated partial thromboplastin time,thrombin time measured before surgery and 48 hours after surgery were compared between the two groups.Peripheral blood white blood cell count,neutrophil count(N%),C-reactive protein,procalcitonin,interleukin-6 measured 48 hours after surgery were compared between the two groups.Results Volume of intraoperative blood loss in the whole course composite thermal insulation group was significantly lower than that in the routine simple thermal insulation group[(393.84±79.78)mL vs.(434.80±123.49)mL,t=3.11,P<0.05).The incidence of shivering and postoperative infection in the whole course composite thermal insulation group was 10.4%(13/125)and 7.2%(9/125),respectively,which was significantly lower than that in the routine simple thermal insulation group[25.6%(32/125),18.4%(23/125),χ^(2)=9.78,7.02,both P<0.05].At 48 hours after surgery,prothrombin time,activated partial thromboplastin time,thrombin time in the whole course composite thermal insulation group were(10.28±0.48)seconds,(26.97±2.27)seconds,and(14.09±1.36)seconds,respectively,which were significantly shorter than those in the routine simple thermal insulation group[(11.71±0.27)seconds,(27.96±2.25)seconds,(15.91±1.09)seconds,t=7.34,3.43,11.66,all P<0.05].At 48 hours after surgery,white blood cell count,neutrophil count,C-reactive protein,procalcitonin,and interleukin-6 in the whole course composite thermal insulation group were(10.38±2.38)×10^(9)/L,(0.79±0.06),(52.79±20.73)mg/L,(0.13±0.42)μg/L,and(55.73±24.38)ng/L,respectively,which were significantly lower than those in the routine simple thermal insulation group[(12.24±7.05)×109/L,0.81±0.05,(65.38±25.92)mg/L,(0.20±0.97)μg/L,(76.22±39.08)ng/L,t=2.79,2.92,4.24,8.12,4.97,all P<0.05].Conclusion Perioperative whole course composite thermal insulation strategy can improve the coagulation function of pregnant women who are subjected to cesarean section under subarachnoid block,reduce volume of intraoperative blood loss,and decrease incidence of shivering,inflammatory reaction,and postoperative infection.