综合保温管理在脊柱后路手术病人围手术期的应用效果

    Application effects of the perioperative comprehensive thermal insulation management in patients treated with posterior spinal surgery

    • 摘要:
      目的分析综合保温管理对脊柱后路手术病人围手术期低体温、应激反应及并发症的影响。
      方法选择全身麻醉下行脊柱后路手术病人60例,按手术时间顺序分为常规组和综合组,各30例。常规组采用维持手术间温度23℃+非手术区域加盖分段式手术毯;综合组采用时段性室温+皮肤消毒液加热+静脉输注液加热+充气升温毯。记录病人术中失血量、术中输液量、病人苏醒时间、出手术室时间,入手术室时、气管插管后、切皮后1 h、手术结束时的核心温度,术后血糖(GLU)和C反应蛋白(CRP)水平及寒战、低体温、压力性损伤、切口感染发生情况。
      结果综合组病人术中失血量、输液量均明显少于常规组(P<0.01),苏醒时间、出手术室时间均明显短于常规组(P<0.01)。2组病人入手术室时和气管插管后的核心温度差异均无统计学意义(P>0.05);切皮后1 h和手术结束时,常规组核心温度均明显低于综合组(P<0.01)。术前2组病人GLU、CRP水平差异均无统计学意义(P>0.05);术后2组病人GLU、CRP水平均明显升高,但综合组均明显低于常规组(P<0.01)。综合组病人术后并发症总发生率为3.33%,明显低于常规组的30.00%(P<0.01)。
      结论脊柱后路手术病人围手术期采用综合保温管理,可有效稳定病人术中核心体温,减少术中出血量、输液量,缩短病人苏醒及出手术室时间,减轻手术应激反应,降低术后并发症发生率。

       

      Abstract:
      ObjectiveTo analyze the effects of comprehensive thermal insulation management on the perioperative hypothermia, stress response and complications of patients treated with posterior spinal surgery.
      MethodsSixty patients treated with posterior spinal surgery under general anesthesia were divided into the conventional group and comprehensive group(30 cases in each group)according to theorder of operation time.In the conventional group, the operating room temperature was maintained at 23 ℃, and the non-operating area was covered with a segmented surgical blanket.In the comprehensive group, the periodic room temperature, skin disinfectant heating, intravenous infusion heating and inflatable heating blanket were adopted.The intraoperative blood loss, intraoperative infusion volume, waking up time, leaving the operating room time, core temperature at the time of entering the operating room, endotracheal intubation, after 1 h of skin resection and end of the operation, postoperative levels of blood glucose(GLU) and C reactive protein(CRP), and occurrence of shivering, hypothermia, pressure injury and wound infection in two groups were recorded.
      ResultsThe intraoperative blood loss and infusion volume of patients in comprehensive group were significantly less than those in conventional group(P<0.01), and the time of awakening and leaving the operating room in comprehensive group were significantly shorter than those in conventional group(P<0.01).There was no statistical significance in the core temperature between two groups at entering the operating room and after endotracheal intubation(P>0.05).The core temperature in conventional group at 1 h after skin excision and the end of operation were significantly lower than that in comprehensive group(P<0.01).There was no statistical significance in the levels of GLU and CRP between two groups before operation(P>0.05).The levels of GLU and CRP in two groups significantly increased after operation, but which in the comprehensive group were significantly lower than those in the conventional group(P<0.01).The total incidence rate of postoperative complications in the comprehensive group was 3.33%, which was significantly lower than that in conventional group 30.00%(P<0.01).
      ConclusionsThe perioperative comprehensive thermal insulation management for patients treated with posterior spinal surgery can effectively stabilize their intraoperative core body temperature, reduce the intraoperative blood loss and transfusion volume, shorten the time of patients waking up and leaving operating room, relieve the surgical stress response, and reduce the incidence of postoperative complications.

       

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