老年患者腹部手术中体温保护减少苏醒期躁动的发生

摘要

目的：观察围术期体温保护对老年手术患者苏醒期的影响。方法选择择期行开腹手术的老年患者40例，ASAⅠ～Ⅱ级。其中男24例，女16例，年龄65～78岁。将40例患者用完全随机法分为两组，每组20例，分别为常温处理组（ A组）和体温保护组（ B组）。 A组采用薄被盖住下肢并全身覆盖双层手术单；B组除上述措施外，采用无菌区外覆盖充气升温毯、静脉输入液体加温，术中使用加温液体冲洗腹腔和手术切口。采用多功能监护仪持续监测患者的体温变化和生命体征的变化，记录两组患者围术期体温变化和拔管时间。患者拔管后送入麻醉恢复室，记录患者入恢复室时的躁动评分（ RS）。结果与A组比较，B组患者体温较高并较少发生低体温，躁动评分和苏醒期躁动例数明显低（P＜0．01），其中危险性躁动（评分达3分）的患者A组有6例，而B组则仅有2例，两组差异显著（ P＜0．01）。结论采取保暖措施能维持手术过程的体温平稳，有利于手术的顺利进行和术中患者的病情稳定，同时术中采取保暖措施可以明显降低老年手术患者麻醉后苏醒期躁动的发生率，有利于患者的康复。%Objective To observe the effect of body temperature protection of elder laparotomy patients on the happening of restlessness in recovery period .Methods Forty patients were randomly divided into two groups, regular measurements group (group A) and temperature protection group (group B).Each group included 20 patients .All patients including 24 male and 16 female were ASA Ⅰ~Ⅱ, 65~78 years old and suitable for selective laparotomy operation .In group A, thin quilt covering the lower limb and double surgical drape covering the whole body were adopted , while in group B, heatable carpet covering the whole body except the sterile area ,warming infusion fluid and warmed saline washing enterocoelia and surgical wound were adopted , as well as measurements in group A .Body temperature and vital signs of each patient were monitored .And temperature changes during perioperation period and extubation time were recorded .Restlessness score ( RS) was record when the patients were sent to postanesthesia care unit .Results Compared with group A , the body temperature was closer to normal level , while incidence rate of hypothermia was lower .Restlessness score of group B and the number of restless patients had apparently different with that of group A , and the number of dangerous restlessness ( RS>3 ) was 6 in group A and 2 in group B.Conclusions Body temperature protection measurements are helpful in stabilizing the body temperature in surgery and hence benefit the success of operation and stability of patients'condition .These measurements also decrease the incidence rate of restlessness during anesthesia recovery period and contribute to recovery of patients .