【摘要】 目的探讨不同保温方式对老年全髋关节置换术患者体温和热舒适度的影响。方法研究的纳入标准:经影像学检查确诊为股骨颈骨折;年龄≥65岁;根据美国麻醉医师协会制定的分级标准进行分级为Ⅰ～Ⅱ级;无语言交流障碍;术后入麻醉恢复室（PACU）进行麻醉复苏。排除标准:凝血功能异常者;患有耳道疾病者;甲状腺功能亢进或甲状腺功能低下者;免疫功能异常者;病态性肥胖症;术前4周有发热或感染患者。选择于青岛市市立医院麻醉手术科在腰硬联合麻醉下行单侧全髋关节置换术的老年患者120例,采用随机数字表法将患者分为4组,每组30例,分别为:充气式升温毯组（A组）、液体加温组（B组）、充气式升温毯联合液体加温组（M组）和对照组（C组）,记录并比较4组患者入室时（T₁）、切皮时（T₂）、手术结束时（T₃）和出室时（T₄）的鼓膜温度,及围术期计划外低体温发生率、麻醉恢复室停留时间、寒战发生情况和热舒适度。计量资料采用Kolmogorov-Smirnov法进行正态检验,对于符合正态分布且方差齐性的计量资料比较,采用方差分析或t检验;对于不符合正态分布和/或方差不齐的计量资料比较,采用秩和检验。计数资料比较应用卡方检验或Fisher确切概率法。结果4组患者T₁时鼓膜温度差异无统计学意义（F=0. 461,P> 0. 05）;在T₂～T₄时,与C组比较,A组（T₂～T₄:t=11. 504、10. 056、14. 205）和M组（T₂～T₄:t=13. 710、12. 086、19. 101）患者鼓膜温度明显升高（P <0. 05）,而B组患者比较差异无统计学意义（T₂～T₄:t=1. 840、-1. 386、1. 371,P> 0. 05）;与A组比较,B组（T₂～T₄:t=9. 628、10. 409、11. 315）和C组（T₂～T₄:t=11. 504、10. 056、14. 205）患者鼓膜温度明显降低（P <0. 05）,M组（T₂～T₄:t=-1. 493、-1. 072、-1. 179）鼓膜温度差异无统计学意义（P>0. 05）。与C组比较,B组患者低体温事件发生率（x²=0. 073）、寒战发生次数与程度（x²=0. 077）、PACU停留时间（t=-0. 250）、热舒适度评分（U=438. 000）差异无统计学意义（P> 0. 05）; A组和M组低体温事件发生率（C组vs A组:x²=5. 963,C组vs M组:x²=4. 356）、寒战发生次数与程度（C组vs A组:x²=6. 667,C组vs M组:x²=6. 667）、PACU停留时间明显降低（C组vs A组:t=-3. 701,C组vs M组:t=-4. 023）,热舒适度评分明显升高（C组vs A组:U=206. 500,C组vs M组:U=211. 500）（P <0. 05）。结论单纯采取充气式升温毯可维持全髋关节置换术老年患者术中体温平稳,降低低体温和寒战发生次数,减少PACU停留时间,提高热舒适度,为患者提供有效的围术期体温保护。更多还原

【Abstract】 Objective To investigate the effect of different thermal interventions on body temperature and thermal comfort of patients undergoing total hip replacement operation. Methods Inclusion criteria:diagnosis of femoral neck fracture by imaging examination,age not less than 65,American Society of Anesthesiologists （ASA） statusⅠ ～ Ⅱ,no difficulty in verbal communication,postoperative anesthesia recovery room （PACU） for anesthesia resuscitation. Exclusion criteria: abnormal coagulation function,suffering from ear canal disease,thyroid dysfunction,immune dysfunction,pathological obesity,patients with fever or infection four weeks before surgery. A total of 120 patients with total hip replacement operation were randomly divided into four groups,30 cases in each group: forced-air warming system group （group A）,fluid warming group （group B）,forced-air warming system combined with fluid warming group （group M） and control group （group C）. The tympanic membrane temperatures at admission （T₁）,skin incision （T₂）,the end of operation （T₃） and exited from operating room （T₄） were recorded and compared among the four groups. The incidence of inadvertent perioperative hypothermia and shivering,thermal comfort and the durationin postanesthesia care unit （PACU） were recorded and compared. The Kolmogorov-Smirnov method was used first to test the normality of all the variables. Variance analysis and t-test were used to analyze the normal distribution data,the Mann – Whitney U-test was used to analyze the skewed distribution data. Chi-square test and Fisher’s exact probability method were used to analyze thenumeration data. Results The tympanic membrane temperature at T₁ had no statistical significance among four groups （F = 0. 461,P > 0. 05）. The temperature in the group A （T₂-T₄: t = 11. 504,10. 056,14. 205） and group M （T₂-T₄: t = 13. 710,12. 086,19. 101） had statistically significant difference when compared with that in group C in T₂-T₄ （P < 0. 05）. There was no significant difference of tympanic membrane temperature in group C and group B （T₂-T₄: t =1. 840,-1. 386,1. 371; P > 0. 05） and also no difference in group A and group M （P > 0. 05）. There was no significant difference of inadvertent perioperative hypothermia,shivering,PACU duration and the thermal comfort score in group C and group B （P > 0. 05）. Group A and group M had lower incidence of inadvertent perioperative hypothermia （group C vs A: x²= 5. 963,group C vs M: x²= 4. 356） and shivering （group C vs A: x²= 6. 667,group C vs M: x²= 6. 667） than those in group C （P < 0. 05）,and the PACU duration （group C vs A:t =-3. 701,group C vs M: t =-4. 023） in group A and group M were significantly shorten than those in group C （P < 0. 05）,the thermal comfort （group C vs group A: U = 206. 500,group C vs group M: U = 211. 500）score was higher in group A and group M than thosein group C （P < 0. 05）. Conclusion The forced-air warming system can maintain the patient ’s body temperature,shorten the PACU duration,reduce the occurrence of shivering,improve the thermal comfort,and provide an effective temperature protection strategy for elder patients when undergoing total hip replacement operation.更多还原