圍術期綜合保溫對腹腔鏡手術患者體溫及術后恢復的影響

戴珩　陳洪艷　宋云

【摘要】 目的：探討圍術期綜合保溫措施對腹腔鏡手術患者體溫、術后恢復及并發癥的影響。方法：選擇2016年7-12月行婦科腹腔鏡手術的患者60例，按照隨機數字表法將其分為觀察組和對照組，各30例。兩組麻醉方法一致，觀察組給予綜合保溫措施，對照組采用常規保溫措施。觀察記錄兩組入室到術畢離室的體溫、術中出血量、手術時間、液體輸入量、蘇醒時間及拔管時間；離開麻醉后監測治療室（postanesthesia care unit，PACU）前10 min行血氣分析，記錄pH值和乳酸水平，觀察兩組在PACU期間寒顫及躁動的并發癥發生情況。結果：兩組手術時間、出血時間及液體輸入量比較，差異均無統計學意義（P>0.05）；觀察組乳酸含量顯著高于對照組（P<0.05）；但兩組血漿pH值比較，差異無統計學意義（P>0.05）；觀察組蘇醒時間和拔管時間均短于對照組（P<0.05）；觀察組術后寒顫及躁動發生例數均顯著低于對照組（P<0.05）。結論：圍術期綜合保溫能有效降低圍術期低體溫的發生，促進術后恢復，減少術后并發癥的發生，提高患者手術舒適度及滿意度。

【關鍵詞】 圍術期保溫； 腹腔鏡手術； 體溫； 術后恢復

Influence of Perioperative Warming on Body Temperature and Postoperative Recovery of Patients Undergoing Laparoscopic Surgery/DAI Heng，CHEN Hongyan，SONG Yun.//Medical Innovation of China，2017，14（32）：144-148

【Abstract】 Objective：To investigate the effect of perioperative warming on body temperature，postoperative recovery and complications of patients undergoing laparoscopic surgery.Method：60 cases of gynecological laparoscopic surgeries from July to December 2016 were selected，according to the random number table method，they were divided into observation group and control group，30 cases in each group.The anesthesia methods of two groups were consistent，the observation group was given comprehensive insulation measures，and control group was given conventional thermal insulation measures.The body temperature，blood loss，operation time，liquid input，recovery time and extubation time of two groups were observed and recorded，blood gas analysis was performed 10 min before leaving PACU，the pH value and lactic acid level were recorded，during PACU，the occurrence of chils and restlessness between two groups were observed.Result：The operation time，bleeding time and fluid input of two groups were compared，the difference were not statistically significant（P>0.05），the lactic acid content of observation group was significantly higher than that of control group（P<0.05），while the pH values of the two groups were compared，the difference was not significantly different（P>0.05），the recovery time and extubation time of observation group were shorter than those of control group（P<0.05），the chils and restlessness of observation group were significantly lower than those of control group（P<0.05）.Conclusion：Perioperative warming can effectively reduce the occurrence of perioperative hypothermia，also improve postoperative recovery，reduce postoperative complications，and improve patient comfort and satisfaction.

【Key words】 Perioperative warming； Laparoscopic surgery； Body temperature； Postoperative recoveryendprint

First-authors address：Chongqing Maternal and Child Health Hospital，Chongqing 401147，China

doi：10.3969/j.issn.1674-4985.2017.32.037

圍術期低體溫是手術麻醉過程中的一種常見并發癥，據報道，其發生率高達50%～90%[1]，且其與術后感染、出血及認知障礙的發生密切相關。全身麻醉時因麻醉藥物抑制溫度調節，擴張全身血管，有50%以上的患者術中處于低體溫狀態，其中約33%的患者低于35℃[2]。腹腔鏡手術因其創傷小，術后疼痛輕，腸道功能恢復快，住院時間短，疤痕小等優點，在婦科手術中廣泛開展。但腹腔鏡手術常規使用常溫或冷的CO2氣體，圍術期輸入冷液體及大量的腹腔沖洗液，使得腹腔鏡手術圍術期極易發生低體溫[3]，因此，其發生率及顯著的不良影響越來越多。圍術期低體溫已得到廣大臨床工作者的重視，棉被覆蓋、電熱毯加溫等保溫手段也得到普遍的應用，但術中僅采用單一的保溫措施很難維持患者圍術期體溫。本研……