系统分级复温措施干预对老年骨科手术患者寒战和术后认知功能的影响

Effect of systematic graded rewarming intervention on shivering and postoperative cognitive function in elderly patients undergoing orthopaedic surgery

目的探讨系统分级复温措施在老年骨科手术患者中的应用效果。方法选取2019年3月至2022年3月于九江市中医医院行骨科手术的92例老年患者作为研究对象,按随机数字表法将其分为对照组和观察组,每组各46例。对照组患者采取常规复温干预,观察组患者实施系统分级复温措施,两组均持续干预至手术结束。比较两组患者不同时间段[入手术室后(T_(1))、麻醉诱导后(T_(2))、麻醉30 min(T_(3))、术中60 min(T_(4))、手术结束(T_(5))]的体温变化;比较两组患者干预前后的认知功能、凝血功能;比较两组患者的并发症总发生率。结果T_(1)时,两组患者的体温比较,差异无统计学意义(P>0.05);观察组患者T_(2)、T_(3)、T_(4)、T_(5)时的体温分别为(36.52±0.26)、(36.49±0.31)、(36.47±0.37)、(36.56±0.32)℃,均高于对照组的(36.21±0.24)、(36.01±0.28)、(35.82±0.35)、(35.94±0.42)℃,差异有统计学意义(P<0.05);观察组患者干预后的认知功能检查量表(MMSE)评分为(20.25±3.41)分,高于对照组的(17.86±3.39)分,差异有统计学意义(P<0.05);观察组患者干预后的凝血酶时间(TT)为(18.56±1.30)s、凝血酶原时间(PT)为(15.96±1.32)s、活化部分凝血活酶时间(APTT)为(31.25±2.83)s,均长于对照组的(14.89±1.29)、(11.08±1.28)、(25.39±2.54)s,纤维蛋白原(Fbg)为(2.15±0.38)g/L,低于对照组的(3.62±0.53)g/L,差异有统计学意义(P<0.05);观察组患者的并发症总发生率为4.35%,低于对照组的17.39%,差异有统计学意义(P<0.05)。结论系统分级复温措施能够维持老年骨科手术患者体温于恒定状态,改善患者术后认知功能和凝血功能,降低寒战等并发症的发生风险。

Objective To explore the effect of systematic graded rewarming intervention in elderly patients undergoing orthopaedic surgery.Methods A total of 92 elderly patients who underwent orthopedic surgery in Jiujiang Hospital of Traditional Chinese Medicine from March 2019 to March 2022 were selected as the research objects and divided into control group and observation group according to the random number table method,with 46 cases in each group.The control group received routine rewarming intervention,the observation group implemented systematic and graded rewarming measures,and the two groups continued to intervene until the end of the operation.The temperature changes of the two groups were compared at different time periods(after entering the operating room[T_(1)],after induction of anesthesia[T_(2)],30 min of anesthesia[T_(3)],60 min of operation[T_(4)],and the end of operation[T_(5)]).The cognitive function and coagulation function of the two groups were compared before and after intervention.The total incidence of complications was compared between the two groups.Results There was no significant difference in body temperature between the two groups after operation room(T_(1))(P>0.05).The temperature of the observation group at T_(2),T_(3),T_(4) and T_(5) were(36.52±0.26),(36.49±0.31),(36.47±0.37)and(36.56±0.32)℃respectively,which were higher than those of the control group of(36.21±0.24),(36.01±0.28),(35.82±0.35),(35.94±0.42)℃,with statistically significant differences(P<0.05).After the intervention,the score of mini-mental state examination(MMSE)in the observation group was(20.25±3.41)point,which was higher than that in the control group of(17.86±3.39)points,the difference was statistically significant(P<0.05).After the intervention,the thrombin time(TT)in the observation group was(18.56±1.30)s,prothrombin time(PT)in the observation group was(15.96±1.32)s,activated partial thromboplastin time(APTT)in the observation group was(31.25±2.83)s,which were longer than those in the control group of(14.89±1.29),(11.08±1.28),(25.39±2.54)s,and fibrinogen(FBG)in the observation group was(2.15±0.38)g/L,which was lower than that in the control group of(3.62±0.53)g/L,the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was 4.35%,which was lower than 17.39%in the control group,the difference was statistically significant(P<0.05).Conclusion Systematic graded rewarming intervention can maintain the body temperature of elderly orthopaedic patients in a constant state,improve postoperative cognitive function and coagulation function,and reduce the risk of complications such as shivering.