复杂创伤患者手术治疗中浅表大血管保温技术联合保温护理的效果研究

陈肖; 鲍映雪; 周月琴; 汪立刚

doi:10.16766/j.cnki.issn.1674-4152.003227

复杂创伤患者手术治疗中浅表大血管保温技术联合保温护理的效果研究

doi: 10.16766/j.cnki.issn.1674-4152.003227

1.
杭州市萧山区中医院(浙江中医药大学附属江南医院)外科，浙江杭州 311200
2.
浙江省人民医院手术室，浙江杭州 310014

基金项目:

浙江省医药卫生科技计划项目 2022KY496

详细信息

通讯作者:
鲍映雪，E-mail：wai344cazan@163.com

中图分类号: R473.6 R472
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- 文章访问数: 133
- HTML全文浏览量: 62
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-12
- 网络出版日期: 2023-11-23

The effect of superficial large vessel warming technology combined with warming care in the surgical management of patients with complex trauma

1.
Surgery Department of Xiaoshan District Hospital of Traditional Chinese Medicine (Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, Zhejiang 311200, China

摘要

摘要: 目的探究对复杂创伤手术患者行浅表大血管保温技术联合保温护理的临床效果，为手术中保温方案的选择提供参考。方法选取2018年4月—2023年3月于杭州市萧山区中医院接受复杂创伤手术治疗的患者84例，采用随机数字表法将其分为对照组和观察组，每组42例。围手术期给予对照组传统充气式温毯仪加温，观察组采用浅表大血管保温联合保温护理策略。比较2组不同时点的体温变化，观察患者麻醉苏醒质量等情况。结果观察组患者手术结束时和入麻醉室时与入手术室时体温差异无统计学意义(P>0.05)，而对照组患者手术过程中和入麻醉室时与入手术室时体温差异有统计学意义(P < 0.05)。2组患者入室时体温差异无统计学意义，手术开始时至入麻醉室时观察组体温高于对照组(P < 0.05)。观察组低体温[14.29%(6/42)]，热损伤(0)，寒战[4.76%(2/42)]发生率均低于对照组[35.71%(15/42)、16.67%(7/42)、21.43%(9/42), 均P < 0.05]。观察组手术时间、清醒时间、拔管时间及呼吸恢复时间均短于对照组(均P < 0.05)，术中出血量、输注液量低于对照组(均P < 0.05)。2组拔管时血压和心率差异无统计学意义(均P>0.05)，拔管后10 min时观察组血压和心率均低于对照组(均P < 0.05)。结论浅表大血管保温技术联合保温护理能够有效提高复杂创伤手术患者术中体温，减少体温波动，提高麻醉苏醒质量，保障拔管后生命体征恢复正常。
- 复杂创伤 /
- 浅表大血管保温技术 /
- 保温护理
Abstract: Objective To investigate the clinical effect of combined warming technology and warming care for complex trauma patients undergoing surgery, in order to provide a reference for the selection of the warming scheme during surgery. Methods Eighty-four patients who underwent complicated trauma surgery in Xiaoshan District Hospital of Traditional Chinese Medicine from April 2018 to March 2023 were selected. They were randomly divided into the control group and the observation group with 42 cases each. During the perioperative period, the control group was heated by the traditional inflatable warming blanket. The study group was treated with the combination of superficial large vessel heat preservation and warming care. The changes in body temperature and the quality of anesthesia recovery between the two groups were compared at different time points. Results There was no statistically significant difference in body temperature between patients in the observation group at the end of surgery and when entering the anesthesia room and the operating room (P>0.05), while there was a statistically significant difference in body temperature between patients in the control group during surgery and when entering the anesthesia room and the operating room (P < 0.05). There was no statistically significant difference in body temperature between the two groups when entering the operating room. The body temperature of the observation group was higher than that of the control group from the start of surgery to the time of entering the anesthesia room (P < 0.05). The incidence of hypothermia in the observation group was 14.29% (6/42), the incidence of heat injury was 0, and the incidence of shivering was 4.76% (2/42), all of which were lower than the 35.71% (15/42), 16.67% (7/42), and 21.43% (9/42) of the control group (all P < 0.05). The observation group had shorter surgical time, wakefulness time, extubation time, and respiratory recovery time than the control group (all P < 0.05), and less intraoperative bleeding and infusion volume than the control group (all P < 0.05). There was no statistically significant difference in blood pressure and heart rate between the two groups during extubation (all P>0.05). At 10 minutes after extubation, blood pressure and heart rate were lower in the observation group than in the control group (all P < 0.05). Conclusion Superficial large vessels heat preservation technology combined with warming care can effectively improve the intraoperative temperature of patients with complex trauma, reduce temperature fluctuations, improve the quality of anesthesia recovery, ensure the recovery of vital signs after extubation.
- Complex trauma /
- Superficial large vessels heat preservation technology /
- Thermal insulation care

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表 1 2组复杂创伤手术患者一般资料比较

Table 1. Comparison of general information between two groups of patients undergoing complex trauma surgery

项目	对照组(n=42)	观察组(n=42)	统计量	P值
年龄(x±s，岁)	51.93±14.35	49.16±13.26	0.919^a	0.361
性别(例)			0.283^b	0.595
男性	32	34
女性	10	8
BMI(x±s)	23.82±2.67	23.49±2.59	0.575^a	0.567
ASA分级[例(%)]			0.091^b	0.763
Ⅱ级	35(83.33)	36(85.71)
Ⅲ级	7(16.67)	6(14.29)
创伤类型[例(%)]			0.229^b	0.973
交通事故	18(42.86)	19(45.24)
机器损伤	9(21.43)	8(19.05)
坠落伤	9(21.43)	10(23.81)
其他	6(14.29)	5(11.90)
注：^a为t值，^b为χ²值。

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表 2 2组复杂创伤手术患者体温变化比较(x±s，℃)

Table 2. Comparison of temperature changes between two groups of patients undergoing complex trauma surgery (x±s, ℃)

组别	例数	T1	T2	T3	T4	T5	T6
对照组	42	36.63±0.44	36.25±0.32^a	36.27±0.31^a	36.23±0.45^a	36.26±0.43^a	36.29±0.45^a
观察组	42	36.59±0.41	36.39±0.29^a	36.41±0.33^a	36.42±0.34^a	36.44±0.38	36.54±0.43
t值		0.431	2.101	2.004	2.183	2.033	2.603
P值		0.668	0.039	0.048	0.032	0.045	0.011
注：与T1时比较，^aP < 0.05。

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表 3 2组复杂创伤手术患者麻醉苏醒质量比较(x±s，min)

Table 3. Comparison of the quality of anesthesia recovery between two groups of patients undergoing complex trauma surgery (x±s, min)

组别	例数	清醒时间	拔管时间	呼吸恢复时间
对照组	42	16.31±3.12	18.38±3.61	16.01±3.43
观察组	42	12.83±3.74	13.49±3.20	14.12±3.35
t值		4.631	6.569	2.554
P值		< 0.001	< 0.001	0.013

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表 4 2组复杂创伤手术患者血压和心率比较(x±s)

Table 4. Comparison of blood pressure and heart rate between two groups of patients undergoing complex trauma surgery (x±s)

组别	例数	收缩压(mmHg)		舒张压(mmHg)		心率(次/min)
组别	例数	拔管时	拔管后10 min	拔管时	拔管后10 min	拔管时	拔管后10 min
对照组	42	127.68±12.03	124.36±11.22	74.86±8.12	72.01±5.93	96.36±7.82	85.49±8.09
观察组	42	125.16±13.11	117.13±11.51	75.89±7.93	65.12±6.35	95.63±8.14	80.36±8.37
t值		0.918	2.915	0.588	5.139	0.419	2.856
P值		0.361	0.005	0.558	< 0.001	0.676	0.005
注：1 mmHg=0.133 kPa。

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表 5 2组复杂创伤手术患者手术情况比较(x±s)

Table 5. Comparison of surgical conditions between two groups of patients undergoing complex trauma surgery (x±s)

组别	例数	手术时间 (min)	术中出血量 (mL)	术中输注液量 (mL)
对照组	42	189.59±27.45	132.98±13.97	1 171.46±96.35
观察组	42	171.85±24.44	113.74±10.12	1 081.51±85.52
t值		3.128	7.228	4.525
P值		0.002	< 0.001	< 0.001

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表 6 2组复杂创伤手术患者寒战发生率比较[例(%)]

Table 6. Comparison of the incidence of shivering between two groups of patients undergoing complex trauma surgery [cases (%)]

组别	例数	0级	1级	2级	3级	发生寒战
对照组	42	33(78.57)	4(9.52)	3(7.14)	2(4.76)	9(21.43)
观察组	42	40(95.24)	1(2.38)	1(2.38)	0	2(4.76)
统计量		2.267^a				5.126^b
P值		0.023				0.024
注：^a为U值，^b为χ²值。

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