手术室前移后延式体温保护用于经皮肾镜碎石术患者的临床研究

The clinical study on the body temperature protection pretreated and delayed in the operation room in the patients undergoing percutaneous nephrolithotomy

目的:探讨手术室前移后延式体温保护对经皮肾镜碎石术患者核心体温、内环境和麻醉复苏的影响。方法:选取接受经皮肾镜碎石手术的患者78例为研究对象。随机分为试验组和对照组各39例。试验组采用前移后延式强化体温保护措施,即患者入室采用3M充气式加温设施进行预热,以后采用持续的保温措施至麻醉复苏期间;对照组未实施预热,仅采用持续的保温措施至麻醉复苏期间。监测患者入室后、麻醉诱导前、手术开始30 min、60 min、90 min、手术结束时、入恢复室时、离开恢复室时的鼻咽温度;分别于术前、术毕和离开复苏室时抽取动脉血监测血液电解质和血气分析;观察麻醉复苏时间、寒战发生例数和出复苏室时的Edward评分。结果:试验组在麻醉后的各个时点的鼻咽温不同程度的高于对照组,差异有统计学意义(P<0.05);试验组术毕和离开复苏室时的动脉血pH值、HCO_(3)^(-)、K^(+)水平高于对照组,差异有统计学意义(P<0.05);试验组术毕和离开复苏室时血乳酸(LAC)、葡萄糖(Glu)水平低于对照组,差异有统计学意义(P<0.05);试验组麻醉复苏时间短于对照组,差异有统计学意义(P<0.05);试验组的寒战发生例数低于对照组,差异有统计学意义(P<0.05);两组出复苏室时的Edward评分差异无统计学意义(P>0.05)。结论:手术室前移后延式体温保护可有效提高经皮肾镜碎石术患者围术期的核心温度,维持内环境的稳定、缩短麻醉复苏时间、降低寒战发生率,有利于患者的术后康复。

Objective To investigate the effects of the body temperature protection pretreated and delayed in the operation room on the body temperature,the internal environment and the anesthesia recovery in patients undergoing percutaneous nephrolithotomy.Method Seventy-eight patients who underwent PCNL in our hospital were selected as research object.They were randomly divided into the research group and the control group,with 39 cases in each group.The body temperature protection pretreated and delayed was used in the research group.That is,the preheating by 3M inflatable heating facilities after patients entering in the operation room and the continuous heat preservation measures were used until the recovery of anesthesia.And only the continuous heat preservation measures were used until the recovery of anesthesia without the preheating in the control group.The naso-pharyngeal temperature was monitored after the patients entering the operation room,before anesthesia induction,at 30min,60min,90min after the surgery begining,at the end of surgery,at the moment of entering and leaving the recovery room.The arterial blood samples were drawn before surgery,at the end of surgery and at the moment of leaving the recovery room for blood electrolyte and gas analysis;The anesthesia recovery time,cases of shivering and the Edward score when leaving the recovery room were observed and recorded.Results The naso-pharyngeal temperature at all time-points after anesthesia in the research group were higher than those in the control group(P<0.05);The arterial levels of pH,HCO_(3)^(-)and K^(+)at the end of surgery and at the moment of leaving the recovery room in the research group were higher than those in the control group(P<0.05);The blood levels of Lactate and Glucose at the moment of leaving the recovery room in the research group were lower than those in the control group(P<0.05);The anesthesia recovery time in the research group was shorter than that in the control group.(P<0.05);The cases of shivering in the research group was less than that in the control group(P<0.05);There was no statistical differences of the Edward score in the both group at the moment of leaving the recovery room.(P>0.05).Conclusion The body temperature protection pretreated and delayed in the operation room can improve core body temperature,maintain the stability of the internal environment,shorten the recovery time after anesthesia,reduce the incidence of shivering and facilitate the postoperative recovery in the patients undergoing PCNL.