手术室全程积极保温在老年腹股沟疝手术中的应用

Application of whole-course active thermal insulation in operating room during inguinal hernia surgery for the elderly

目的探讨手术室全程积极保温策略在老年腹股沟疝手术中的应用效果。方法选取2020年10月至2022年10月在北京积水潭医院收治的86例老年腹股沟疝患者作为研究对象,采用1∶1简单随机数表法分为观察组与对照组,各43例。对照组予以手术室常规保温策略,观察组予以手术室全程积极保温策略。比较2组手术相关指标、围手术期[入室时(T1)、麻醉后10 min(T2)、手术开始后20 min(T3)和手术结束时(T4)]体温,术前、术后第2天应激水平[皮质醇、肾上腺素和去甲肾上腺素(NE)]及术中不良事件的发生率。结果观察组术中出血量(18.36±4.65)ml、气管拔管时间(23.65±4.27)min和自主意识恢复时间(20.12±3.46)min低于对照组[(34.53±4.92)ml、(27.76±4.35)min、(25.85±3.77)min],差异均有统计学意义(P<0.05)。2组患者T2、T3和T4体温均逐渐降低,但观察组均高于对照组[(36.71±0.18)℃vs(36.41±0.20)℃、(36.68±0.21)℃vs(36.12±0.23)℃、(36.65±0.24)℃vs(35.86±0.25)℃],差异均有统计学意义(P<0.05)。术后第2天2组患者皮质醇、肾上腺素和NE水平均明显升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。观察组低体温、寒战发生率明显低于对照组(4.65%vs 18.60%,0 vs 13.95%),差异均有统计学意义(P<0.05)。结论手术室全程积极保温策略可以降低腹股沟疝手术患者低体温及寒战发生率,并有助于维持患者术中体温水平,降低应激性损伤。

Objective To explore the application effect of whole-course active thermal insulation strategy in operation room during inguinal hernia surgery for the elderly.Methods A total of 86 elderly patients with inguinal hernia admitted to Beijing Jishuitan Hospital were enrolled as the subjects between October 2020 and October 2022.According to 1:1 simple random number table method,they were divided into observation group and control group,with 43 cases in each group.The control group was given routine thermal insulation strategy in operating room,while observation group was given whole-course active thermal insulation strategy in operating room.The surgical related indexes,perioperative temperature[immediately after entering the room(T1),10 min after anesthesia(T2),20 min after the start of surgery(T3),the end of surgery(T4)],stress indexes[cortisol,epinephrine,norepinephrine(NE)]before and 2 d after surgery,and the incidence of intraoperative adverse events were compared between the two groups.Results The intraoperative blood loss,tracheal extubation time and recovery time of autonomous consciousness in observation group were significantly lower/shorter than those in control group[(18.36±4.65)ml vs(34.53±4.92)ml,(23.65±4.27)min vs(27.76±4.35)min,(20.12±3.46)min vs(25.85±3.77)min](P<0.05).At T2,T3 and T4,body temperature in both groups decreased continuously,which was higher in observation group than in control group[(36.71±0.18)℃vs(36.41±0.20)℃,(36.68±0.21)℃vs(36.12±0.23)℃,(36.65±0.24)℃vs(35.86±0.25)℃](P<0.05).On the second day after surgery,levels of cortisol,epinephrine and NE in both groups were significantly increased,which were lower in observation group than in control group(P<0.05).The incidence of hypothermia and chill in observation group was significantly lower than that in control group(4.65%vs 18.60%,0 vs 13.95%)(P<0.05).Conclusion The whole-course active thermal insulation strategy in operating room can reduce the incidence of hypothermia and chill in elderly patients undergoing inguinal hernia surgery,which is beneficial to maintain intraoperative body temperature and reduce stress injury.