不同体温保护措施对老年结直肠癌手术病人苏醒质量的影响

    Effect of different temperature protection measures on quality of recovery in elderly patients with colorectal cancer surgery

    • 摘要:
      目的评价不同体温保护措施对老年结直肠癌手术病人苏醒质量的影响。
      方法选取行择期结直肠癌根治术老年病人120例,运用随机数字表法分为常规组(C组)、输液加温组(Y组)、加温毯加温组(T组)和输液加温联合加温毯加温组(YT组),各30例。所有病人腹腔冲洗液常规使用温0.9%氯化钠溶液冲洗,C组不做特殊处理,Y组病人在此基础上对输液管道用输液加温器进行37 ℃恒温加温处理,T组在病人入室30 min开始使用加温毯并维持病人体温在36~37 ℃,YT组同时使用输液加温器和加温毯。收集病人的一般资料,记录入复苏室后病人自主呼吸恢复时间、术后睁眼时间、拔管时间、复苏室停留时间及苏醒期躁动发生情况,于术前和术后1、3、7 d进行MMSE评分,记录病人术后谵妄发生情况。
      结果T组、YT组病人术中体温均明显高于C组和Y组(P < 0.01)。T组、YT组病人自主呼吸恢复时间、术后睁眼时间、拔管时间、复苏室停留时间和苏醒期躁动发生率均明显低于C组和Y组(P < 0.01);Y组与C组病人自主呼吸恢复时间、术后睁眼时间、拔管时间、复苏室停留时间和苏醒期躁动发生率差异均无统计学意义(P>0.05)。C组、Y组病人术后第1天MMSE评分明显低于术前(P < 0.01);T组与YT组围术期MMSE评分差异均无统计学意义(P>0.05)。T组、YT组病人术后谵妄发生率低于C组和Y组(P < 0.05);Y组与C组术后谵妄发生率差异无统计学意义(P>0.05)。
      结论加温毯加温单独或联合输液加温能有效缩短病人术后苏醒时间,降低术后认知功能障碍及谵妄的发生率,提高病人术后苏醒质量,有利病人术后早期康复。

       

      Abstract:
      ObjectiveTo evaluate the effect of different temperature protection measures on the quality of recovery in elderly patients with colorectal cancer surgery.
      MethodsA total of 120 elderly patients scheduled for radical resection of colorectal cancer were selected and divided into conventional group(group C), infusion heating group(group Y), heating blanket heating group(group T) and infusion heating combined with heating blanket heating group(group YT)(30 cases in each group) by random number table method.The patient′s abdominal cavity was routinely rinsed with warm 0.9% sodium chloride solution.Group C did not receive special treatment, group Y was heated with 37 ℃ constant temperature heating treatment of the infusion warmer for the infusion pipeline on the basis of group C, group T began to apply heating blanket at 30 min after entering the operation room to maintain the patient′s body temperature at 36-37 ℃, and group YT was heated with infusion warmer and heating blanket.The general information of the patients was collected.The recovery time of spontaneous breathing, postoperative eye opening time, extubation time, stay time in the resuscitation room and occurrence of agitation in recovery period were recorded.MMSE scores were evaluated before operation, 1, 3 and 7 days after operation, and the occurrence of postoperative delirium was recorded.
      ResultsThe intraoperative body temperature in group T and group YT was significantly higher than that in group C and group Y(P < 0.01).The recovery time of spontaneous breathing, postoperative eye opening time, extubation time, stay time in the resuscitation room and incidence of agitation in recovery period in group T and group YT were significantly lower than those in group C and group Y(P < 0.01), and there was no significant difference in recovery time of spontaneous breathing, postoperative eye opening time, extubation time, stay time in the resuscitation room and incidence of agitation in recovery period between group Y and group C(P>0.05).The MMSE score in group C and group Y on the first day after operation was significantly lower than that before operation(P < 0.01), and there was no significant difference in perioperative MMSE score between group T and group YT(P>0.05).The incidence of postoperative delirium in group T and group YT was lower than that in group C and group Y(P < 0.05), and there was no significant difference in the incidence of postoperative delirium between group Y and group C (P>0.05).
      ConclusionsHeating with heating blanket alone or combined with infusion heating can effectively shorten the postoperative recovery time, reduce the incidence of postoperative cognitive dysfunction and delirium, improve the quality of postoperative recovery, which is conducive to early postoperative rehabilitation.

       

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