ERAS理念下的多模式保温联合多感官促醒刺激对老年髋部骨折全麻手术患者的影响

施春娟; 钟宝英; 鲍映雪

doi:10.16766/j.cnki.issn.1674-4152.003692

ERAS理念下的多模式保温联合多感官促醒刺激对老年髋部骨折全麻手术患者的影响

doi: 10.16766/j.cnki.issn.1674-4152.003692

1.
浙江省立同德医院手术室，浙江杭州 310012
2.
浙江省人民医院手术室，浙江杭州 314408

基金项目:

浙江省医药卫生科技项目 2022KY496

详细信息

通讯作者:
鲍映雪，E-mail：wai344cazan@163.com

中图分类号: R473.6 R614.2
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- 文章访问数: 25
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- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-26

Effects of multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept on elderly patients undergoing general anesthesia for hip fracture

1.
Operation Room of Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China

摘要

摘要: 目的基于ERAS理念构建多模式保温联合多感官促醒刺激方案，探讨其对老年髋部骨折全麻手术患者的影响，旨在为优化围手术期护理提供理论参考。方法选取2019年9月—2023年9月在浙江省立同德医院择期进行老年髋部骨折全麻手术患者102例，采用随机数字表法分为2组，对照组51例，采取传统保温措施和语言唤醒方案；观察组51例，采取以ERAS理念为指导的多模式保温联合多感官促醒刺激方案，比较2组体温、应激情况、麻醉苏醒质量以及不良反应发生率。结果观察组麻醉诱导后(T1)、手术开始时(T2)、手术40 min(T3)、手术结束时(T4)体温均高于对照组(P<0.05)。T1~T4时刻的皮质醇(Cor)、去甲肾上腺素(NE)水平均低于对照组(P<0.05)。自主呼吸恢复时间[(5.21±1.09)min vs.(7.09±1.32)min]、意识恢复时间[(16.23±3.12) min vs.(25.90±4.77)min]以及麻醉恢复室滞留时间[(33.22±5.67)min vs.(50.09±8.23)min]均短于对照组(P<0.05)。总不良反应发生率(9.80% vs. 29.41%)低于对照组(χ²=6.220, P=0.013)。结论 ERAS理念下的多模式保温联合多感官促醒刺激可维持老年髋部骨折全麻手术患者术中体温稳定，缓解应激反应，提高麻醉苏醒质量，降低不良反应发生率。
- 髋部骨折 /
- 全身麻醉 /
- 体温管理 /
- 多感官促醒 /
- 应激反应 /
- 躁动
Abstract: Objective Based on the ERAS concept, a multi-mode thermal insulation combined with multi-sensory awakening stimulation program was constructed to explore its influence on elderly patients undergoing general anesthesia for hip fracture, aiming to provide theoretical reference for optimizing perioperative nursing. Methods A total of 102 elderly patients undergoing general anesthesia for hip fracture at Tongde Hospital of Zhejiang Province from September 2019 to September 2023 were selected and divided into two groups by random number table method. The control group (n=51) were given traditional heat preservation measures and language awakening program, while the observation group (n=51) was treated with a multi-mode thermal insulation combined with multi-sensory awakening stimulation program guided by ERAS concept. Differences in body temperature, stress levels, quality of anesthesia recovery, and incidence of adverse reactions were compared between the two groups. Results The body temperature of the observation group was higher than that in the control group after anesthesia induction (T1), the beginning of surgery (T2), 40 min after surgery (T3), and at the end of surgery (T4, P<0.05). Levels of cortisol (Cor) and norepinephrine (NE) at T1-T4 were lower in the observation group than those in the control group (P<0.05). Recovery times of spontaneous respiration [(5.21±1.09) min vs. (7.09±1.32) min], consciousness [(16.23±3.12) min vs. (25.90±4.77) min], and retention in the anesthesia recovery room [(33.22±5.67) min vs. (50.09±8.23) min] were shorter than those in the control group (P<0.05). The incidence of adverse reactions in the observation (9.80% vs. 29.41%) was lower than that in the control group (χ²=6.220, P=0.013). Conclusion The multi-mode thermal insulation combined with multi-sensory awakening stimulation under ERAS concept can maintain the stability of body temperature during operation, relieve stress response, improve the quality of anesthesia recovery, and reduce the incidence of adverse reactions in elderly patients undergoing general anesthesia for hip fracture.
- Hip fracture /
- General anesthesia /
- Body temperature management /
- Multi-sensory awakening /
- Stress response /
- Restlessness
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表 1 2组老年髋部骨折全麻手术患者一般资料比较

Table 1. Comparison of general data between the two groups of elderly patients undergoing general anesthesia for hip fracture

组别	例数	性别 (男/女，例)	年龄 (x±s，岁)	BMI (x±s)	受教育年限 (x±s, 年)	ASA分级 (Ⅰ/Ⅱ级，例)	入院时体温 (x±s, ℃)	手术时间 (x±s, min)	术中输液量 (x±s, mL)
对照组	51	19/32	80.33±9.80	21.09±2.43	5.87±1.23	28/23	36.51±0.32	130.23±15.13	2 012.45±16.23
观察组	51	19/32	78.75±9.84	21.33±3.56	6.09±0.78	24/27	36.42±0.40	132.99±18.27	2 010.98±20.75
统计量			0.817^a	0.398^a	1.079^a	0.628^b	1.255^a	0.831^a	0.399^a
P值			0.416	0.692	0.283	0.428	0.213	0.408	0.691
注：^a为t值，^b为χ²值。

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表 2 2组老年髋部骨折全麻手术患者不同时间点体温比较(x±s，℃)

Table 2. Comparison of body temperature between two groups of elderly patients undergoing general anesthesia for hip fracture at different time points(x±s, ℃)

组别	例数	T0	T1	T2	T3	T4	F值	P值
对照组	51	36.68±0.34	36.33±0.45	36.19±0.56	36.10±0.39	36.00±0.51	5.231	<0.001
观察组	51	36.66±0.41	36.53±0.31	36.47±0.49	36.35±0.41	36.26±0.52	1.281	0.451
F值		0.566	20.091	28.124	35.903	44.321
P值		0.890	<0.001	<0.001	<0.001	<0.001

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表 3 2组老年髋部骨折全麻手术患者不同时间点Cor水平比较(x±s，nmol/L)

Table 3. Comparison of Cor levels at different time points between the two groups of elderly patients undergoing general anesthesia for hip fracture(x±s, nmol/L)

组别	例数	T0	T1	T2	T3	T4	F值	P值
对照组	51	213.64±20.45	227.78±15.87	259.78±23.12	277.89±20.09	239.09±15.34	9.092	<0.001
观察组	51	209.12±27.34	220.34±18.67	240.09±16.32	258.34±19.45	230.23±14.23	12.312	<0.001
F值		0.989	30.231	36.431	40.091	43.566
P值		0.368	<0.001	<0.001	<0.001	<0.001

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表 4 2组老年髋部骨折全麻手术患者不同时间点NE比较(x±s，pg/mL)

Table 4. Comparison of NE between two groups of elderly patients undergoing general anesthesia for hip fracture at different time points(x±s, pg/mL)

组别	例数	T0	T1	T2	T3	T4	F值	P值
对照组	51	135.67±15.63	144.56±18.45	189.45±15.67	196.77±14.23	149.90±17.34	10.211	<0.001
观察组	51	131.09±19.45	135.23±20.41	160.90±15.77	177.89±20.91	138.77±20.01	15.436	<0.001
F值		1.211	29.441	30.981	35.221	38.542
P值		0.196	<0.001	<0.001	<0.001	<0.001

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表 5 2组老年髋部骨折全麻手术患者麻醉苏醒质量比较(x±s，min)

Table 5. Comparison of anesthesia recovery quality between two groups of elderly patients undergoing general anesthesia for hip fracture(x±s, min)

组别	例数	自主呼吸恢复时间	意识恢复时间	麻醉恢复室滞留时间
对照组	51	7.09±1.32	25.90±4.77	50.09±8.23
观察组	51	5.21±1.09	16.23±3.12	33.22±5.67
t值		7.843	13.369	12.055
P值		<0.001	<0.001	<0.001

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表 6 2组老年髋部骨折全麻手术患者不良反应发生率比较[例(%)]

Table 6. Comparison of adverse reaction incidence in elderly patients undergoing general anesthesia for hip fracture between the two groups[cases(%)]

组别	例数	低体温	寒战	苏醒延迟	苏醒期躁动	合计
对照组	51	6(11.76)	4(7.84)	3(5.88)	2(3.92)	15(29.41)
观察组	51	2(3.92)	1(1.96)	0	2(3.92)	5(9.80)
χ²值		2.170	0.841	1.374	0.260	6.220
P值		0.141	0.359	0.241	0.610	0.013

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