摘要
目的基于循证实践构建非体外循环冠脉搭桥(OPCABG)患者术中非计划性低体温的最佳预防措施,旨在降低OPCABG患者术中非计划性低体温的发生率,减少各类并发症。方法系统检索国内外各大数据库中关于OPCABG患者术中非计划性低体温预防措施的证据,检索时限为建库至2019年8月31日。由3名研究者独立对文献进行筛选及评价,获得OPCABG患者术中低体温预防的最佳证据。采用整群抽样方法将2020年1—4月在浙江省人民医院行OPCABG的29例患者作为对照组,将2021年1—4月行OPCABG的27例患者作为观察组。比较两组患者的入室体温、麻醉后1 h体温、出室体温、术中最低体温、术后第1个24 h胸腔闭式引流瓶内引流量、术后ICU停留时长及术后住院时长的差异。结果共纳入文献17篇,获取相关证据20条,经专家评估,选取适合本研究环境的最佳证据,应用于临床。对照组患者的入室体温为(36.62±0.30)℃,与观察组的(36.49±0.28)℃比较,差异无统计学意义(t=2.85,P>0.05);对照组麻醉后1 h体温、出室体温、术中最低体温分别为(35.83±0.30)、(36.05±0.49)、(35.50±0.31)℃,观察组分别为(36.43±0.38)、(36.62±0.27)、(36.21±0.28)℃,两组比较差异有统计学意义(t值分别为37.65、23.76、58.13;P<0.01)。对照组患者术中的非计划性低体温的发生率为93.1%(27/29),观察组为11.1%(3/27),两组比较差异有统计学意义(χ^(2)=34.568,P<0.01)。对照组术后第1个24 h胸腔闭式引流瓶内的引流量为(260.0±70.3)ml,观察组为(212.1±44.3)ml,两组比较差异有统计学意义(t=-3.025,P<0.01)。对照组的ICU停留时长、住院时长分别为(49.0±13.4)h、(12.2±3.5)d,观察组为(39.8±13.8)h、(10.5±2.5)d,两组比较差异有统计学意义(t值分别为-2.524、-2.035;P<0.05)。结论OPCABG患者术中非计划性低体温的最佳预防措施为该类手术术中低体温的预防提供了科学严谨的流程和规范,有效降低了患者术中低体温发生率,能够维持患者术中核心温度的稳定,减少术后出血,缩短ICU停留时长及住院时长,值得临床推广。
Objective To establish the best preventive measures for inadvertent perioperative hypothermia(IPH)in patients undergoing off-pump coronary artery bypass grafting(OPCABG)based on evidence,in order to reduce the incidence of IPH and reduce various complications in OPCABG patients.Methods The evidence of preventive measures for IPH in OPCABG patients was systematically searched in major databases at home and abroad.The retrieval time limit was from the establishment of the database to August 31,2019.Three researchers independently screened and evaluated the literature to obtain the best evidence for the prevention of IPH in patients with OPCABG.Using the cluster sampling method,29 patients who underwent OPCABG in Zhejiang Provincial People's Hospital from January to April 2020 were selected as the control group,while 27 patients who underwent OPCABG from January to April 2021 were selected as the observation group.The differences in body temperature at admission,body temperature at 1 hour after anesthesia,body temperature after leaving the department,minimum intraoperative body temperature,drainage volume in the first 24 hours after surgery,length of stay in ICU and length of hospital stay after surgery were compared between the two groups.Results A total of 17 papers were included,and 20 pieces of relevant evidence were obtained.After evaluation by experts,the best evidence suitable for the research environment was selected and applied in clinical practice.The body temperatures at admission of patients in the control group and the observation group were respectively(36.62±0.30)℃and(36.49±0.28)℃,and the difference was not statistically significant(t=2.85,P>0.05).The body temperature at 1 h after anesthesia,the body temperature after leaving the department and the lowest body temperature during operation were(35.83±0.30),(36.04±0.49)and(35.50±0.31)℃in the control group,and(36.43±0.38),(36.62±0.27)and(36.21±0.28)℃in the observation group,respectively.The difference between the two groups were statistically significant(t=37.65,23.76,58.13;P<0.01).The incidence of IPH was 93.1%(27/29)in the control group and 11.1%(3/27)in the observation group,and the difference was statistically significant(χ^(2)=34.568,P<0.01).The drainage volume in the first 24 h after operation in the control group was(260.0±70.3)ml and that in the observation group was(212.1±44.3)ml,and the difference between the two groups was statistically significant(t=-3.025,P<0.01).The length of ICU stay and hospital stay in the control group were respectively(49.0±13.4)h and(12.2±3.5)d,while those in the observation group were(39.8±13.8)h and(10.5±2.5)d,and the differences between the two groups were statistically significant(t=-2.524,-2.035;P<0.05).Conclusions The best preventive measures for inadvertent perioperative hypothermia in patients with OPCABG provide scientific and rigorous procedures and specifications for the prevention of inadvertent perioperative hypothermia in this type of surgery,effectively reducing the incidence of inadvertent perioperative hypothermia and maintaining the intraoperative core temperature stability of patients,reduce postoperative bleeding and shorten the length of ICU stay and hospital stay,which is worthy of clinical promotion.
作者
王梦甜
童彬
王小明
徐俊
谭奇凯
Wang Mengtian;Tong Bin;Wang Xiaoming;Xu Jun;Tan Qikai(Operating Room,Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College,Hangzhou 310014,China;Nursing Department,Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College,Hangzhou 310014,China;Department of Anesthesiology,Hangzhou Ninth People's Hospital,Hangzhou 311225,China)
出处
《中华现代护理杂志》
2022年第25期3394-3404,共11页
Chinese Journal of Modern Nursing
关键词
冠状动脉旁路移植术
非体外循环
术中低体温
预防
术中保温
循证护理
Coronary artery bypass,off-pump
Inadvertent perioperative hypothermia
Prevention
Intraoperative heat preservation
Evidence-based nursing
作者简介
通信作者:童彬,Email:tobyhz2014@163.com。
