围手术期不同体温干预模式对老年患者术后谵妄的影响

Influence of different perioperative body temperature intervention mode on postoperative delirium in elderly patients

目的探讨围手术期不同体温干预模式对老年患者术后谵妄的影响。方法选取2021年9月至2022年12月莆田市第一医院80例择期拟行腹腔镜下胃癌根治术患者作为研究对象,按照随机数字表法将患者分为对照组和多模式保温组,每组40例。对照组采用物理保温,多模式保温组采用输液加温仪输液加温、充气式升温系统等保温措施。观察不同时间点两组患者鼻咽部体温变化,记录两组患者基本信息、手术时间、术中出入量、术中麻醉药用量、术后并发症等情况。术后采用谵妄评定方法对两组患者进行术后谵妄评估。结果多模式保温组患者术后拔管时间和PACU停留时间短于对照组,差异有统计学意义(P<0.05)。麻醉诱导后麻醉维持期体温逐渐降低,多模式保温组T_(5)~T_(7)时刻、对照组T_(4)~T_(7)时刻患者鼻咽部温度均低于本组T0时,差异有统计学意义(P<0.05)。多模式保温组术中低体温的发生率低于对照组,差异有统计学意义(P<0.05)。多模式保温组术后谵妄发生率低于对照组,差异有统计学意义(P<0.05)。两组患者术后谵妄的发作时间和持续时间比较,差异无统计学意义(P>0.05)。结论围手术期多模式保温可以降低长时间手术老年患者术中低体温发生率,从而减少术后谵妄发生率。

Objective To explore the influence of different perioperative body temperature intervention mode on postoperative delirium in elderly patients.Methods A total of 80 patients who planned to undergo laparoscopic radical gastrectomy in the First Hospital of Putian City from September 2021 to December 2022 were selected as the research objects.According to random number table method,the patients were divided into control group and multi-mode thermal insulation group,with 40 cases in each group.The control group used physical insulation,and the multi-mode thermal insulation group used infusion heating instrument and inflatable heating system.The changes of nasopharyngeal body temperature in the two groups were observed at different time points,and the basic information,operation time,intake and output volume,intraoperative anesthetic dosage and postoperative complications of the two groups were recorded.Postoperative delirium assessment method was used to evaluate postoperative delirium in the two groups.Results The time of extubation and PACU residence in the multi-mode thermal insulation group were shorter than those in the control group,the differences were statistically significant(P<0.05).After anesthesia induction,the body temperature in the anesthesia maintenance period gradually decreased,and the nasopharyngeal temperature of patients in the multi-mode thermal insulation group at T_(5)-T_(7) and the nasopharyngeal temperature of control group at T_(4)-T_(7) were lower than that at T0,with statistical significances(P<0.05).The incidence of intraoperative hypothermia in the multi-mode thermal insulation was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative delirium in multi-mode thermal insulation was lower than that in control group,and the difference was statistically significant(P<0.05).There were no significant differences in the onset and duration of postoperative delirium between the two groups(P>0.05).Conclusion Multi-mode thermal insulation in perioperative period can reduce the incidences of intraoperative hypothermia and postoperative delirium in elderly patients after prolonged operation.