术中输液加温对开腹胃肠道手术患者组织氧合灌注和苏醒期的影响

doi:10.3969/j.issn.1009-976X.2020.04.023

摘要/Abstract

摘要： 目的观察术中输液加温对开腹胃肠道手术患者组织氧合灌注和苏醒期的影响。方法随机选择ASA分级Ⅰ或Ⅱ级拟开腹胃肠道肿瘤手术患者60例,采用随机数字表法其分为对照组、输液加温组（加温组）,每组各30例。对照组患者术中采用常规保温措施;加温组患者在常规保温措施的基础上术中使用输液加温仪持续输液加温,温度设置为41℃。记录两组患者麻醉诱导前10 min（T₀）、手术开始时（T₁）、手术开始1 h（T₂）、手术开始2 h（T₃）、术毕（T₄）时的鼻咽温、中心静脉血氧饱和度（ScvO₂）和动脉血乳酸（ABL）;比较两组患者麻醉苏醒期自主呼吸恢复时间、拔管时间、PACU停留时间,寒颤、躁动发生率,躁动评分（RS）、Ramsay镇静评分（RSS）及患者麻醉满意度。结果加温组T₂、T₃、T₄时的鼻咽温、ScvO₂均较对照组高（P < 0.05）,ABL较对照组低,但差异无统计学意义（P > 0.05）;与对照组相比,加温组麻醉苏醒期自主呼吸恢复时间、拔管时间、PACU停留时间明显缩短,寒颤、躁动发生率显著降低,躁动评分（RS）更低、Ramsay镇静评分（RSS）及患者麻醉满意度更高（P < 0.05）。结论术中输液加温可保证开腹胃肠道手术患者术中良好组织氧合灌注,有利于快速麻醉复苏,明显减少患者麻醉苏醒期寒颤及躁动发生,提高患者麻醉满意度。

关键词: 输液加温, 胃肠道手术, 麻醉苏醒期, 组织灌注

Abstract: Objective To observe the effect of intraoperative fluid warming on tissue perfusion and recovery period of patients undergoing open gastrointestinal tract cancer resection. Methods Sixty ASAⅠorⅡpatients undergoing selective open gastrointestinal tract cancer resection were randomized into two groups （n=30 each）：control group and fluid warming group. The patients in the control group used conventional heat preservation measures during operation, while the patients in the fluid warming group used a fluid warmer （41℃） to keep infusion warming on the basis of conventional heat preservation measures during operation. The changes of nasopharyngeal temperature, ScvO₂, ABL were recorded at the time of 10 min before anesthesia induction, beginning of operation （T₁）, 1 h after the begin of operation （T₂）, 2 h afterthe begin of operation （T₃）, and at the end of operation （T₄） were recorded in the two groups. The time of respiratory recovery, extubation and PACU stay were observed. Meanwhile, shivering, restlessness, RS score, RSS score and patient satisfaction to anesthesia were also compared between the two groups. Results Compared with the control group, the nasopharynx temperature and ScvO₂ of the intervention group at T₂, T₃ and T₄ were higher （P<0.05）. And the ABL was lower, but the difference was not statistically significant; Compared with the control group, the time of respiratory recovery, extubation and PACU stay in the intervention group were also shorter, the incidence of shivering and restlessness were lower （P<0.05）. Conclusion Intraoperative fluid warming can ensure good tissue perfusion in patients undergoing open tract cancer resection, is conducive to rapid anesthesia recovery, significantly reduce the occurrence of shivering and restlessness in patients during anesthesia recovery period, and improve the patient satisfaction to anesthesia, which is worth popularizing.

Key words: tissue perfusion, fluid warming, anesthesia recovery period, gastrointestinal tract cancer resection

中图分类号:

R614

杨雪莹, 张雪荣, 徐永腾. 术中输液加温对开腹胃肠道手术患者组织氧合灌注和苏醒期的影响[J]. 岭南现代临床外科, 2020, 20(04): 507-511.

YANG Xue-ying, ZHANG Xue-rong, XU Yong-teng. Effect of fluid warming in patients undergoing open gastrointestinal tract cancer resection[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 507-511.

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