保溫干預對人工關節置換術患者術中生命體征的影響

[摘要] 目的 探討保溫護理干預對人工關節置換術患者術中生命體征的影響。方法 將100例擬行人工關節置換術的患者隨機分為常溫組和溫熱組各50例。常溫組采用室溫下的靜脈輸液及進行術區沖洗，而溫熱組實施包括靜脈輸液及術區沖洗液加溫在內的保溫護理干預。比較兩組患者麻醉后30min、術中2h、術畢時的體溫、心率及平均動脈壓(MAP)和心肌耗氧量，同時于術中1h、術中2h和術畢時記錄兩組患者低體溫和高血糖發生情況。結果 保溫組術中2h和術畢時的體溫明顯高于常溫組同時點，差異有統計學意義，均P<0.01(t=5.432，8.485);保溫組麻醉30min、術中2h和術畢時的心率、MAP和心肌耗氧量與常溫組同時點比較差異無統計學意義，均P>0.05;術中2h和術畢時，保溫組的低體溫和高血糖發生率明顯低于常溫組，差異有統計學意義，均P<0.01(χ2=9.333，21.374，7.104，9.890)。結論 術中保溫護理干預能夠有效防止人工關節置換術患者術中體溫下降，有利于控制血糖濃度，且不會對患者循環功能造成影響。

[關鍵詞] 人工關節置換術;溫熱液體;生命體征;護理

[中圖分類號] R47 [文獻標識碼] A [文章編號] 1673-9701(2010)04-84-03

Influence of Intraoperative Warming on Vital Signs in Patients Undergoing Artificial Joint Replacement

LIU FengmingZENG Lingzhi

Taojiang County People’s Hospital in Hunan Province，Taojiang 413400，China

[Abstract] Objective To explore the effect of intraoperative warming intervention on vital signs in patients undergoing artificial joint replacement. Methods A hundred patients scheduled for artificial joint replacement were randomly divided into the room and warming teperature group each comprising 50 cases. The former received intravenous infusion and washing in operative area at room temperature，while the latter received the intraoperative warming interventions including intravenous infusion and washing liquid warming. The levels of the body temperature，heart rate，mean arterial pressure(MAP) and myocardial oxygen consumption were compared 30min after anesthesia，2h after operation and operation completion between both two groups，and the incidences of hypothermia and hyperglycemia were noted 1h，2h after surgery and operation completion. Results The body temperature at 2h after operation and operation completion were markedly higher in the warming group than in the room temperature group，with significant differences between two groups，both P<0.01(t=5.432，8.485). There were no significant differences in heart rate，MAP，and myocardial oxygen consumption at varying time point，all P>0.05; The incidence rates for the hypothermia and hyperglycemia 2h after operation and after operation completion were considerably lower in the warming group than in the room temperature group，showing significant differences，all P<0.01(χ2=9.333，21.374，7.104，9.890). Conclusion Intraoperative warming can effectively prevent the body temperature of the joint replacement patients from decreasing，aid in controlling the blood glucose level，and have no effect on circulatory function.

[Key words] Joint replacement;Warming liquid;Vital signs;Nursing care

在圍手術期，手術患者由于術前術區消毒液蒸發、內臟或肢體大面積和長時間的暴露、大量補液及麻醉藥對機體體溫調節功能的抑制等很容易造成低體溫。人工關節置換術是近年來開展的一項大手術，術中常需靜脈輸入大量液體及反復進行術區沖洗，加之手術步驟復雜繁瑣，手術時間長，患者術中易發生低體溫。輕度低體溫在某些情況下是有利的，但多數情況是一種不良刺激，機體會做出一系列應激反應，對患者術中、術后生理功能影響很大，尤以老年患者為著[1]?！?br>