【作者】 韩宇；

【导师】 赵国庆；

【作者基本信息】 吉林大学 ， 麻醉学（专业学位）， 2021， 硕士

【摘要】 目的:观察围术期多模式积极保温措施对腹腔镜结直肠癌手术患者术中低体温发生率、术中出血量、术后寒战、苏醒时间、术后三天发热率及术后炎性反应指标等的影响。方法:选取本院择期行腹腔镜结直肠癌根治术且符合入选标准的患者共100例作为研究对象,按随机数字表法将其分成2组,A组为多模式积极保温组,利用加温空气保护毯,在患者麻醉诱导前30min对患者进行预保温,所有静脉补液、冲洗液及输血被加温到体温水平,术中持续监测鼻咽温,手术过程中患者的目标核心温度定为37℃。B组为常规体温管理组,按照目前临床常规进行体温管理,从患者入室至手术结束给予常规单层棉被保温处理,所有静脉补液、冲洗液及输血保持室温。术中持续监测体温,当患者核心体温≤35.5℃时,给予补救性充气加温保护毯,以防止体温继续下降。两组患者均进行常规诱导及气管插管,术中采用全凭静脉麻醉,术毕常规苏醒拔管。记录两组患者术中低体温发生率、术中出血量、术后寒战、苏醒时间、术后三天发热率、术前及术后第二天外周血中性粒细胞、淋巴细胞、血小板计数值等指标。结果:两组患者的年龄、性别、BMI、手术时间等指标均无统计学意义(P>0.05)。A组术中低体温发生率小于B组,差异有统计学意义(P<0.05)。两组病人术中出血量比较差异无统计学意义(P>0.05)。A组术后苏醒时间短于B组,差异有统计学意义(P<0.05)。A组患者术后寒战发生率小于B组患者,差异有统计学意义(P<0.05)。两组均有部分患者术后三天内出现发热(体温>38℃),差异无统计学意义(P>0.05)。两组患者术后第二日外周血中性粒细胞-淋巴细胞比值(NLR)及血小板-淋巴细胞比值(PLR)比术前均有不同程度升高,A组NLR及PLR升高幅度小于B组,差异有统计学意义(P<0.05)。结论:对于腹腔镜结直肠癌手术患者,与常规体温管理组相比,多模式积极保温组减少了术中低体温发生率,减少了术后寒战发生率,缩短了术后麻醉苏醒时间,降低了术后第二日NLR、PLR升高幅度。但对于术后三天发热率及术中出血量无明显影响。更多还原

【Abstract】 Objective:To observe the effects of perioperative multimodal active body temperature protection on the incidence of intraoperative hypothermia,intraoperative blood loss,postoperative chills,recovery time,postoperative fever rate three days after operation and postoperative inflammatory response indexes of patients undergoing laparoscopic colorectal cancer surgery.Methods:Line selection in our hospital undergoing elective laparoscopic radical prostatectomy and meets the criteria for the patients with colorectal cancer,A total of 100 cases as the research object,according to random number table method into its divided into 2 groups,group A multiple model heat preservation group actively,using heating air security blanket,30 min before patients anesthesia induction heat preservation,carried out on the patient all intravenous rehydration,flushing fluid and blood transfusion was warmed to body temperature level,intraoperative continuous monitoring of nasopharyngeal temperature,surgery patients with goals in the process of the core temperature is 37 ℃;Group B was the conventional body temperature management group,which received body temperature management according to the current clinical practice.Patients were given conventional monolayer cotton quilt insulation treatment from admission to the end of the operation,and all intravenous fluid rehydration,rinse fluid and blood transfusion were kept at room temperature.The body temperature was continuously monitored during the operation.When the patient’s core body temperature was less than 35.5℃,the patient was given a remedial inflatable heating protective blanket to prevent the continuous drop of body temperature.Routine induction and endotracheal intubation were performed in both groups.Intravenous anesthesia was used during the operation.Routine recovery and extubation were performed after the operation.The incidence of intraoperative hypothermia,intraoperative blood loss,postoperative chills,recovery time,fever rate three days after surgery,peripheral blood neutrophils,lymphocytes,thrombotometer values and other indexes were recorded in 2 groups.Results:There was no statistical significance in age,gender,BMI,surgery time and other indexes between 2 groups(P > 0.05).The incidence of intraoperative hypothermia in group A was lower than that in group B,and the difference was statistically significant(P<0.05).There was no significant difference in the amount of intraoperative blood loss between the two groups(P>0.05).The postoperative recovery time of group A was shorter than that of group B,and the difference was statistically significant(P<0.05).The incidence of postoperative shivering in group A was lower than that in group B,and the difference was statistically significant(P<0.05).Some patients in both groups had fever within 3days after surgery(body temperature > 38℃),the difference was not statistically significant(P > 0.05).The ratio of neutrophil-lymphocyte(NLR)and platelet-lymphocyte(PLR)in peripheral blood of both groups on the second day after surgery increased to varying degrees compared with that before surgery,and the increase of NLR and PLR in group A was less than that in group B,the difference was statistically significant(P<0.05).Conclusion:For patients undergoing colorectal cancer surgery,compared with the conventional body temperature management group,the multi-mode active insulation group reduced the incidence of intraoperative hypothermia,the incidence of postoperative shivering,the time of postoperative anesthesia recovery,and the increase of NLR and PLR on the second day after surgery.However,there was no significant effect on the fever rate and intraoperative blood loss three days after operation.更多还原