自制截石位加温罩在开腹直肠癌根治术中的应用效果评价

Evaluation of the application of self-made lithotomy heating mask in radical resection of rectal cancer

目的:评价术中使用自制截石位加温罩对开腹直肠癌根治术患者术中、术后体温及术后短期结局指标的影响。方法:采取类实验研究设计方法,选取中国科学院大学宁波华美医院2021年2—7月的100例开腹直肠癌患者为研究对象。采用信封盲抽法分为试验组和对照组各50例。对照组采用常规方法保温,试验组采用自制截石位加温罩保温,比较2组患者在术前、术中、术后不同时间点核心体温的变化;比较2组患者从手术开始到返回病房后6 h期间意外低体温、寒战的发生率以及麻醉恢复时间、术后48 h内各类并发症发生率的差异。结果:试验组麻醉后30 min至入病房3 h,10个时间点的核心体温值均高于对照组,差异有统计学意义(t值为3.48~37.30,均P<0.01)。从手术开始到返回病房后6 h,试验组围手术期意外低体温的发生率为2%(1/50),低于对照组的24%(12/50),差异有统计学意义(χ^(2)=11.06,P<0.05)。试验组寒战的发生例数为10例,低于对照组的22例,差异有统计学意义(χ^(2)=6.62,P<0.05)。试验组的苏醒时间、拔管时间、麻醉恢复室停留时间分别为(8.44±2.83)、(13.05±4.72)、(74.51±11.82)min,短于对照组的(15.35±2.09)、(17.62±3.28)、(89.14±9.19)min,差异有统计学意义(t=-13.89、-5.62、-6.91,均P<0.01);试验组躁动、谵妄、恶心呕吐发生例数分别为3、1、2例,低于对照组的13、7、8例,差异有统计学意义(χ^(2)=7.44、4.89、4.00,均P<0.05)。2组患者心脏不良事件发生率比较差异无统计学意义(P>0.05)。结论:开腹直肠癌手术术中应用自制截石位加温罩能有效改善术中、术后不同时间点低体温的风险,降低围手术期寒战、躁动、术后恶心呕吐及谵妄发生率,缩短患者苏醒时间、拔管时间,预防术后并发症,临床上具有实用价值。

Objective To evaluate the effect of self-made lithotomy heating mask on intraoperative and postoperative body temperature and short-term postoperative outcome indicators in patients undergoing radical resection of rectal cancer.Methods Using the method of quasi experimental research design,100 patients with open rectal cancer in Ningbo Huamei Hospital of the University of Chinese Academy of Sciences from February to July 2021 were selected as the research objects.The patients were divided into experimental group and control group with 50 cases in each group.The control group was kept warm by routine methods,and the experimental group was kept warm by self-made lithotomy heating hood.The changes of core temperature at different time points before,during and after operation were compared between the two groups.The incidence of accidental hypothermia and shivering,the recovery time of anesthesia,and the incidence of various complications within 48 hours after operation were compared between the two groups after operation from the beginning of the operation to 6 hours after returning to the ward.Results From 30 minutes after anesthesia to 3 hours after entering the ward,the core temperatures of the experimental group at 10 time points were higher than that of the control group,and the differences were statistically significant(t values were 3.48-37.30,all P<0.01).From the beginning of surgery to 6 h after returning to the ward,the incidence of perioperative accidental hypothermia in the experimental group was 2%(1/50),lower than 24%(12/50)in the control group,and the difference was statistically significant(χ^(2)=11.06,P<0.05).The number of cases of shivering in the experimental group was 10,lower than that in the control group of 22,the difference was statistically significant(χ^(2)=6.62,P<0.05).The recovery time,extubation time and stay time in anesthesia recovery room of the experimental group were(8.44±2.83),(13.05±4.72),(74.51±11.82)min,which were shorter than those of the control group(15.35±2.09),(17.62±3.28),(89.14±9.19)min,and the difference was statistically significant(t=-13.89,-5.62,-6.91,all P<0.01).The number of cases of agitation,delirium and nausea and vomiting in the experimental group was 3,1 and 2 respectively,which was lower than 13,7 and 8 in the control group,and the difference were statistically significant(χ^(2)=7.44,4.89,4.00,all P<0.05).There was no significant difference in the incidence of adverse cardiac events between the two groups(P>0.05).Conclusions The application of self-made lithotomy heating mask in open rectal cancer surgery can effectively improve the risk of hypothermia at different time points during and after surgery,reduce the incidence of shivering,restlessness,postoperative nausea,vomiting and delirium,shorten the time of awakening and extubation,and prevent postoperative complications.It has practical value in clinic.