灌注液温度控制对经尿道绿激光前列腺剜切术患者安全性的影响

Effect of perfusion fluid temperature control on the safety of patients undergoing transurethral prostate enucleation by green-light laser

目的:研究灌注液温度对经尿道绿激光前列腺剜切术患者安全性的影响及护理对策。方法:对2019年10月~2021年4月皖南医学院第二附属医院收治的60例前列腺增生患者进行经尿道绿激光前列腺剜切手术,采用随机数字表法分成对照组和观察组,每组30例,术中分别使用室温及加温灌注液,比较两组患者术中体温、手术时间、灌注液使用量、平均动脉压、心率、舒适度评价、寒颤发生率等指标。结果:两组患者年龄、术前前列腺体积、手术时间、灌注液使用量比较差异无统计学意义(P>0.05),对照组术后有8例(26.7%)发生寒颤,观察组术后1例(3.3%)发生寒颤,两组差异有统计学意义(P<0.05),观察组心率、平均动脉压水平等血流动力学指标稳定,术中体温轻度下降,与术前体温比较差异无统计学意义(P>0.05),对照组术中体温下降明显,与术前比较差异有统计学意义(P<0.05),在不同手术时间节点对照组较观察组体温下降明显(P<0.05),观察组术中舒适度高于对照组(P<0.05)。结论:术中使用接近人体中心体温的37℃灌注液,可显著提高患者术中舒适度,降低术中低体温、术后寒颤的发生率,对提高围手术期安全性具有重要意义。

Objective:To investigate the impact of perfusion fluid temperature on the safety and nursing countermeasures in patients undergoing transurethral enucleation of the prostate using green-light laser.Methods:Sixty patients with benign prostatic hyperplasia undergone transurethral enucleation by green-light laser in our hospital were included between October 2019 and April 2021,and equally randomized to two groups by random number table.Room temperature perfusion fluid or heated perfusion fluid was respectively applied to the patients in control group and observational group during operation.The two groups were compared concerning intraoperative body temperature of the patients,operative time,perfusion volume,mean arterial pressure,heart rate,patient′s evaluation on the comfort experienced in operation,and incidence of chills.Results:There was no significant difference in the age,prostate volume,operative time and consumption of perfusion fluid between two groups(P>0.05),yet postoperative chills occurred in 8 patients in the control group(26.7%),and only one in the observational group(3.3%),the difference was significant(P<0.05).Hemodynamic indexes,such as heart rate and mean arterial pressure,remained stable in the patients of observational group,although patients in this group had slightly decreased body temperature,yet the change of intraoperative body temperature was insignificant compared to preoperative body temperature(P>0.05).Evidently decreased body temperature during operation was seen in the control group compared to that of before operation(P<0.05).Decrease of body temperature in different time point in surgery was dominant in patients in the control group(P<0.05),and patients in the observational group had better comfort than those in the control group.Conclusion:Perfusion fluid at 37℃that is close to the central body temperature during operation can significantly improve the patients′comfort,reduce the incidence of hypothermia and incidence of postoperative chills,which is of greatly significant to improve the perioperative safety in patients undergoing transurethral enucleation of the prostate using green-light laser.