摘要
目的进一步探讨不同保温措施对全麻下经尿道前列腺电切术患者低体温的治疗效果。方法将120例全麻下行择期TURP的患者随机分为4组:A组(对照组:未采取特殊体温保护)、B组(冲洗液加温组)、C组(充气式温毯机加温组)、D组(冲洗液和温毯机联合加温组)。观察并比较4组患者入手术室(T1)、全麻后10 min(T2)、持续冲洗10 min(T3)、持续冲洗30 min(T4)、持续冲洗60 min(T5)、停止冲洗(T6)、手术结束(T7)7个时点的鼻咽温、血流动力学指标、心肌耗氧量,并记录血浆细胞因子水平(术前、术后3 h)、术后并发症、患者满意度、住院时间。结果T3开始,各时间点4组鼻咽温比较差异均具有统计学意义(P<0.01)。D组鼻咽温波动幅度小于A组、B组、C组,差异具有统计学意义(P<0.05)。心率(HR)、平均动脉压(MAP)、心机耗氧量波动幅度D组小于其他3组,差异具有统计学意义(P<0.05)。术后3 h,A组患者血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)浓度明显降低,IL-10血清浓度明显升高,与B组、C组、D组相比较,差异具有显著统计学意义(P<0.01)。与A组相比,B组、C组、D组寒颤、恶心、呕吐、肌肉酸痛、躁动发生率显著增加(P<0.01);对患者治疗满意度进行调查及统计分析,B组、C组、D组与A组相比较,差异均具有统计学意义(P<0.01),而这3组比较,差异并不具有统计学意义(P>0.05);同时,与A组相比较,B组、C组以及D组住院时间明显缩短(P<0.05)。结论应用冲洗液与充气式温毯机联合加温对于降低TURP患者低体温的发生、保持血流动力学稳定、减轻患者的不适、术后寒颤等并发症方面具有相对良好的效果。
Objective To further investigate the therapeutic effects of different temperature maintenance strategies on hypothermia in patients undergoing transurethral resection of the prostate(TRUP)under general anesthesia.Methods A total of 120 patients undergoing elective TURP under general anesthesia were randomized into four groups:Group A received traditional treatment without special hypothermia prevention measures;group B received irrigation fluid warming);group C received forced-air blanket warming;and group D received irrigation fluid warming+forced-air blanket warming).The nasopharyngeal temperature,hemodynamic changes and myocardial oxygen consumption of the patients in the four groups were observed and compared at seven time points:entry into the operating room(T1),10 min after general anesthesia(T2),10 min after continuous irrigation(T3),30 min after continuous irrigation(T4),60 min after continuous irrigation(T5),termination of irrigation(T6),and at the end of anesthesia(T7).Meanwhile,the plasma cytokines before operation and at 3 h after operation,postoperative complications,patient satisfaction,and length of stay were observed and compared.Results Statistically significant differences in nasopharyngeal temperature were observed among the four groups at various time points since T3(P<0.01).Group D exhibited significantly milder fluctuation of nasopharyngeal temperature than the groups A,B and C(P<0.05).The fluctuations of heart rate(HR),mean arterial pressure(MAP),and myocardial oxygen consumption in group D were milder than the other three groups,showing significant differences(P<0.05).At 3 h postoperatively,the serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)dropped significantly in group A,while the serum interleukin-10(IL-10)level rose significantly,as compared to groups B,C and D(P<0.01).Significantly increased incidences of chills,shivering,nausea,vomiting,muscular soreness,and agitation were observed in groups B,C and D in contrast to group A(P<0.01).The rate of patient satisfaction with treatment were significantly higher in groups B,C and D than in group A(P<0.01).No significant differences were observed among groups B,C and D(P>0.05).Furthermore,the lengths of stay in groups B,C and D were significantly shorter than in group A(P<0.05).Conclusions The combination of irrigating fluid warming and forced-air blanket warming can reduce the incidence of hypothermia,maintain the hemodynamic stability,reduce the discomfort of patients,and reduce postoperative shivering and other complications in patients undergoing TURP under general anesthesia.
作者
马吉宁
梁宵
王志萍
曹君利
MA Jining;LIANG Xiao;WANG Zhiping;CAO Junli(Xuzhou Medical University Jiangsu Province Key Laboratory of Anesthesiology,Xuzhou,Jiangsu 221004,China;Department of Anesthesiology,Wuxi Second Hospital Affiliated to Nanjing Medical University,Wuxi,Jiangsu 214002)
出处
《徐州医科大学学报》
CAS
2020年第4期281-286,共6页
Journal of Xuzhou Medical University
基金
无锡市卫生计生委员会青年项目(Q201713)。
关键词
前列腺电切
低体温
冲洗液加温系统
充气式加温系统
transurethral resection of the prostate
hypothermia
irrigation fluid warming system
forced-air warming system
作者简介
通信作者:王志萍,E-mail:zhpsqxt@163.com;通信作者:曹君利。
