不同保温方法对脊柱手术患者围术期核心体温和恢复情况的影响

Effects of different warming strategies on perioperative core temperature and patient recovery in spinal surgery

目的比较不同保温方法对脊柱手术患者围手术期核心体温及术后恢复的影响。方法选择行择期全麻脊柱手术患者80例,男45例,女35例,年龄18～80岁,BMI 18～25 kg/m^2,ASAⅠ或Ⅱ级,采用随机数字表法分为四组,静脉输液加温组(FW组);强力空气加温毯加温组(AW组);静脉输液加温+强力空气加温毯组(FA组);入手术室前强力空气加温毯预热30 min,术中静脉输液加温+强力空气加温毯组(PFA组),每组20例。入室前FW组、AW组和FA组不予处理,PFA组于术前等候室采用强力空气加温毯预热30 min。术中FW组输入经血液/液体升温仪加热至41℃的液体直到手术结束。AW组将强力空气加温毯覆盖于患者的下肢部位上方,设定温度为43℃。FA组和PFA组均采用输液加温和强力空气加温毯加温。记录患者在麻醉诱导后、切皮后30 min、切皮后60 min、入PACU 10 min和术后48 h时的核心体温;记录患者术后寒战、恶心呕吐发生情况,患者满意度评分和住院时间。结果切皮后30 min FW组核心体温明显低于PFA组(P<0.01);切皮后60 min和入PACU 10 min时FW组核心体温明显低于AW组、FA组和PFA组(P<0.001)。FW组术后寒战发生率明显高于AW组、FA组和PFA组(P<0.05)。四组患者术后恶心呕吐发生率差异无统计学意义。FW组术后患者满意度评分明显低于AW组、FA组和PFA组(P<0.05)。四组患者术后住院时间差异无统计学意义。结论脊柱手术全麻患者围手术期强力空气加温毯保温效果优于输液加温,提高了患者满意度,而强力空气加温毯联合输液加温及预热并没有明显优于单纯使用强力空气加温毯保温。静脉输液加温、强力空气加温毯加温及预热保温方法对患者术后恢复的影响无差异。

Objective To compare the effects of different warming strategies on patient perioperative core temperature and recovery in spinal surgery.Methods Eighty patients undergoing spinal surgery,45 males and 35 females,aged 18-80 years,BMI 18-25 kg/m^2,ASA physical statusⅠorⅡ,were included in this study.They were randomly assigned to the following four groups(n=20)and received different warming treatments.Fluid warming only(group FW);forced-air warming blanket only(group AW);fluid warming plus forced-air warming blanket(group FA);and patients were pre-warmed with forced-air warming blanket for 30 min before entering the operation room,and then received both fluid warming and forced-air warming blanket treatments intraoperatively(group PFA).Patients in group FW,group AW and group FA were not treated,patients in group PFA were pre-warmed with forced-air warming blanket for 30 min in the waiting room before entering the operation room.Group FW were received fluid warming was heated to 41℃by blood/liquid thermometer until the end of the operation.Group AW were received forced-air warming blanket over the lower limbs of the patients intraoperatively,and the temperature was set at 43℃.Group FA and group PFA were received both fluid warming and forced-air warming blanket treatments intraoperatively.Core temperatures were compared among four groups at the time points of endotracheal intubation,30 min after incision,60 min after incision,10 min in PACU and 48 h after surgery.Moreover,incidences of shivering,nausea and vomiting,patient satisfaction scores and postoperative hospitalization time were recorded.Results Compared with group PFA,the core temperature was significantly lower at 30 min after incision time point in group FW(P<0.01).Compared with group AW,group FA and group PFA,the core temperatures at 60 min after incision and 10 min in PACU time point in group FW were significantly lower(P<0.001).The incidence of shivering in group FW was significantly higher than that of the other three groups(P<0.05).There were no significant differences in incidence of nausea and vomiting.The patient satisfaction score in group FW was significantly lower(P<0.05).There were no significant differences in the postoperative hospitalization time among four groups.Conclusion Treatment of forced-air warming blanket is more effective than that of fluid warming for perioperative warming in patients undergoing spinal surgery under general anaesthesia,which improving patients satisfaction.However,the combination of forced-air warming blanket and fluid warming and pre-warming is not significantly better than forced-air warming blanket only.Postoperative patient recovery was not affected by fluid warming,forced-air warming blanket and pre-warming.