三种加温输液方法加温效果及对腹腔镜手术患者的影响(1)
[摘要] 目的 探讨3种不同加温方法对2～3 h时长腹腔镜手术患者的影响。方法 方便选取福建协和医院2016年8—12月共5个月中66例行腹腔镜手术的患者随机分为3组，每组22例，分为500HW组、250HW组及JW组。每例患者每10 min监测输入患者端液体温度tl及核心温度te直至拔管；同时纪录患者拔管时间、苏醒时间，3组患者所花费的经济成本。结果 与JW组相比， 500HW组患者50 min后患者te由36.45°C显著降低至35.67°C(P<0.05) ，此后亦逐渐下降，至180 min时则显著降低至35.59°C(P<0.05)； 250HW组患者100 min时te由36.40°C显著降低至35.61°C(P<0.05) ，此后亦逐渐下降，至180 min时则显著降低至35.64°C(P<0.05)。与250HW组相比，500HW组在全麻插管70 min为35.73°C，此后的各时间点也均显著降低(P<0.05)；3组患者拔管时间：500HW组为18.2 min显著高于JW组的12.6 min和250HW组的13.8 min，而JW组和250HW组相比差异无统计学意义。结论 250 mL恒温箱加温组能提供和专用输液加温仪同样的加温效果，并在经济效益上提供潜在优势。
[关键词] 核心温度；腹腔镜手术；围术期低温
[中图分类号] R47 [文献标识码] A [文章编号] 1674-0742(2017)10(b)-0074-04
[Abstract] Objective This paper tries to explore the effect of three different heating methods on patients with 2 to 3 hours’ long laparoscopic surgery. Methods 66 patients underwent laparoscopic surgery from August to December 2016 in this hospital were conveniently divided into three groups(n=22)： 500HW group， 250HW group and JW group. Each patient was monitored for every 10 minutes of input fluid temperature tl and core temperature te until extubation； the patient’s extubation time， recovery time， and the economic cost of the three groups were recorded. Results Compared to the JW group， in the 500HW group， the patient’s te decreased significantly from 36.45℃ to 35.67℃(P<0.05) at 50 min， and then decreased to 35.59℃(P<0.05) at 180 min(P<0.05)， and in 250HW group， the te was from 36.40℃ decreased to 35.61℃ at 100 min(P<0.05)， and decreased as time went by， to 35.64℃ at 180 min(P<0.05). Compared with the 250HW group， the 500HW group was 35.73℃ in the general anesthesia for 70 min， and then decreased at each time point(P<0.05). The extubation time in the three groups： 500HW group was 18.2 min， significantly longer than that of the JW group of 12.6 min， and 250HW was 13.8 min， there was no significant difference between the JW group and the 250 HW group. Conclusion The 250HW group can provide the same warming effect as the JW group and provide a potential advantage in economic benefits.
[Key words] Core temperature； Laparoscopic surgery； Peri-operative hypothermia
体温被认定为人体重要的五大生命体征之一。围术期低温(perioperative hypothermia)的定义是指围术期患者核心温度<36°C[1]，研究显示围术期低体温与住院天数的延长和住院费用的增加有关[2-3]。因此围术期对体温的监测和对低体温的预防及治疗至关重要。研究报道术中输入恒温箱的液体可有效减少围术期低体温发生率[4-5]。故该研究选取福建协和医院2016年8—12月共5个月中66例时长为2～3 h的腹腔镜手术患者，比较两种不同加温输液方法的效果患者术中的体温变化、拔管时间及经济效益。
1 对象与方法
1.1 研究对象
入选标准：该研究得到福建医科大学附属协和医院伦理委员会许可，研究前告知患者可能的益处、风险，征得患者同意并签署知情同意书。该研究选取在福建医科大学附属协和医院手术室行全身麻醉且手术时长在2～3 h的腹腔镜手术患者，年龄≥18岁，男女不限。排除标准：①外科术中使用灌洗液患者或术中输入血制品患者；②术前腋温≥37.5°C，或≤35°C患者；甲亢患者、肥胖症患者(BMI≥30 kg/m2)及孕妇；③术前服用ACEI抑制剂或钙离子通道阻滞剂患者。采用随机数字表法将纳入该研究的66例患者分为分为：①500 mL恒温水箱组(500HW组)：500 mL液体置于温度为41°C的恒温箱中加热，患者麻醉诱导后即开始输入该液体；②250 mL恒温水箱组(250HW组)：250 mL液体置于温度为41°C的恒温箱中加热，患者麻醉诱导后即开始输入该液体；③电子输血输液加溫仪(JW组)：患者麻醉诱导后即开始输入经电子输血输液加温后的液体，每组22例。两组患者在手术时间，年龄，体重，性别，术前体温，术中输液量及麻醉药用量上差异无统计学意义，见表1。, http://www.100md.com(俞莹 翁险峰)
[关键词] 核心温度；腹腔镜手术；围术期低温
[中图分类号] R47 [文献标识码] A [文章编号] 1674-0742(2017)10(b)-0074-04
[Abstract] Objective This paper tries to explore the effect of three different heating methods on patients with 2 to 3 hours’ long laparoscopic surgery. Methods 66 patients underwent laparoscopic surgery from August to December 2016 in this hospital were conveniently divided into three groups(n=22)： 500HW group， 250HW group and JW group. Each patient was monitored for every 10 minutes of input fluid temperature tl and core temperature te until extubation； the patient’s extubation time， recovery time， and the economic cost of the three groups were recorded. Results Compared to the JW group， in the 500HW group， the patient’s te decreased significantly from 36.45℃ to 35.67℃(P<0.05) at 50 min， and then decreased to 35.59℃(P<0.05) at 180 min(P<0.05)， and in 250HW group， the te was from 36.40℃ decreased to 35.61℃ at 100 min(P<0.05)， and decreased as time went by， to 35.64℃ at 180 min(P<0.05). Compared with the 250HW group， the 500HW group was 35.73℃ in the general anesthesia for 70 min， and then decreased at each time point(P<0.05). The extubation time in the three groups： 500HW group was 18.2 min， significantly longer than that of the JW group of 12.6 min， and 250HW was 13.8 min， there was no significant difference between the JW group and the 250 HW group. Conclusion The 250HW group can provide the same warming effect as the JW group and provide a potential advantage in economic benefits.
[Key words] Core temperature； Laparoscopic surgery； Peri-operative hypothermia
体温被认定为人体重要的五大生命体征之一。围术期低温(perioperative hypothermia)的定义是指围术期患者核心温度<36°C[1]，研究显示围术期低体温与住院天数的延长和住院费用的增加有关[2-3]。因此围术期对体温的监测和对低体温的预防及治疗至关重要。研究报道术中输入恒温箱的液体可有效减少围术期低体温发生率[4-5]。故该研究选取福建协和医院2016年8—12月共5个月中66例时长为2～3 h的腹腔镜手术患者，比较两种不同加温输液方法的效果患者术中的体温变化、拔管时间及经济效益。
1 对象与方法
1.1 研究对象
入选标准：该研究得到福建医科大学附属协和医院伦理委员会许可，研究前告知患者可能的益处、风险，征得患者同意并签署知情同意书。该研究选取在福建医科大学附属协和医院手术室行全身麻醉且手术时长在2～3 h的腹腔镜手术患者，年龄≥18岁，男女不限。排除标准：①外科术中使用灌洗液患者或术中输入血制品患者；②术前腋温≥37.5°C，或≤35°C患者；甲亢患者、肥胖症患者(BMI≥30 kg/m2)及孕妇；③术前服用ACEI抑制剂或钙离子通道阻滞剂患者。采用随机数字表法将纳入该研究的66例患者分为分为：①500 mL恒温水箱组(500HW组)：500 mL液体置于温度为41°C的恒温箱中加热，患者麻醉诱导后即开始输入该液体；②250 mL恒温水箱组(250HW组)：250 mL液体置于温度为41°C的恒温箱中加热，患者麻醉诱导后即开始输入该液体；③电子输血输液加溫仪(JW组)：患者麻醉诱导后即开始输入经电子输血输液加温后的液体，每组22例。两组患者在手术时间，年龄，体重，性别，术前体温，术中输液量及麻醉药用量上差异无统计学意义，见表1。, http://www.100md.com(俞莹 翁险峰)