不同挡位充气式加温毯用于老年经尿道前列腺电切术患者的效果评价

Effect evaluation of inflatable heating blanket with different gears on elderly patients undergoing transurethral resection of prostate

目的:比较不同挡位充气式加温毯用于老年经尿道前列腺电切术(transurethral resection of prostate,TURP)患者的临床效果。方法:选择东南大学医学院附属江阴医院2021年1月至2022年2月120例老年TURP患者,均采取腰硬联合阻滞,采用随机数字表法均分为对照组(不使用充气式加温毯的常规保温组)、低挡组(充气式加温毯设定为32℃)、中挡组(充气式加温毯设定为38℃)、高挡组(充气式加温毯设定为43℃)。比较阻滞前、阻滞30 min、阻滞60 min、阻滞90 min及术毕各时点各组的鼓膜温度和血流动力学变化[平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)],术中低体温发生率、寒战反应程度,观察阻滞前及术毕各组患者的心理状态,包括恐惧情绪[恐惧视觉模拟评分法(fear visual analogue scale,FVAS)]及焦虑情绪[焦虑自评量表(self rating anxiety scale,SAS)]。结果:阻滞前各组的鼓膜温度、FVAS评分及SAS比较差异均无统计学意义(均P>0.05)。相较于对照组,阻滞30 min、阻滞60 min、阻滞90 min及术毕各时点使用充气式加温毯的低挡组、中挡组、高挡组鼓膜温度更高(均P<0.05);相较于低挡组,阻滞60 min、阻滞90 min及术毕3个时点中挡组与高挡组鼓膜温度更高(均P<0.05);中挡组与高挡组鼓膜温度在各时间点比较差异均无统计学意义(均P>0.05)。相较于对照组,阻滞30 min、阻滞60 min、阻滞90 min及术毕各时点使用充气式加温毯的低挡组、中挡组、高挡组的MAP、HR波动更小(均P<0.05);相较于低挡组,阻滞60 min、阻滞90 min及术毕3个时点中挡组与高挡组MAP、HR波动更小(均P<0.05);中挡组与高挡组MAP、HR波动在各时间点比较差异均无统计学意义(均P>0.05)。中挡组与高挡组术中低体温发生率均低于对照组(均P<0.05),高挡组寒战反应程度低于对照组(P<0.05)。中挡组及高挡组术毕FVAS、SAS评分均低于对照组(均P<0.05)。结论:相较于未使用充气毯保温和充气毯设定温度为低挡(32℃)的TURP患者,设定温度在中、高挡(38℃、43℃)的充气式加温毯应用于老年TURP患者的术中保温效果好,可以降低低体温发生率,改善心理状态,减轻恐惧及焦虑的不良情绪。

Objective:To compare the application effect of inflatable heating blanket with different gears on elderly patients undergoing transurethral resection of prostate(TURP).Method:120 elderly TURP patients selected from the Affiliated Jiangyin Hospital of Southeast University Medical College from January 2021 to February 2022 were randomly divided into the control group(without inflatable heating blanket),low-gear group(tempreture of inflatable heating blanket was set at 32℃),middle-gear group(38℃)and high-gear group(43℃),with 30 patients in each group.The tympanic membrane temperature and hemodynamic changes[mean arterial pressure(MAP),heart rate(HR)]before block,at 30 min after block,at 60 min after block,at 90 min after block,and after operation were compared in the four groups.The incidence of hypothermia and shivering reaction during the operation were compared in the four groups.The psychological states[fear visual analogue scale(FAVS score),self rating anxiety scale(SAS score)]before block and after operation were evaluated and compared in the four groups.Result:There were no significant difference in tympanic membrane temperature,FVAS scores and SAS scores before block in the four groups(all P>0.05).The tympanic membrane temperature at 30 min after block,at 60 min after block,at 90 min after block and after operation in the low,middle and high gear group were higher than the control group(all P<0.05).Compared with the low-gear group,the tympanic membrane temperature in the middle and high gear group were higher(all P<0.05).There were no significant difference in tympanic membrane temperature in middle-gear group and high-gear group at each time point(all P>0.05).Compared with the control group,MAP and HR fluctuated less in the low,middle and high gear group at 30 min,60 min,90 min and after operation(all P<0.05);Compared with the low-grade group,MAP and HR fluctuated less in the middle and high gear group at 60 min after block,at 90 min after block and after operation(all P<0.05);There were no significant difference in MAP and HR fluctuations in middle and high gear group at each time point(all P>0.05).The incidence of hypothermia during the operation in middle-gear group and high-gear group were lower than those in the control group(all P<0.05),the degree of shivering reaction in high-gear group was lower than that in the control group(P<0.05).FVAS scores and SAS scores in middle-gear group and high-gear group were lower than those in the control group after the operation(P<0.05).Conclusion:Compared with TURP patients received routine thermal insulation without inflatable heating blanket or tempreture of inflatable heating blanket was set at low gear(32℃)during the operation,inflatable heating blanket set at middle and high gear(38℃and 43℃)had better thermal insulation effect in elderly TURP patients by reducing the incidence of hypothermia and improving their psychological state,relieving their fear and anxiety.