Effect of temperature protection-based nursing intervention on anesthesia resuscitation and flap outcomes in patients undergoing complex trauma surgery
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摘要:
目的 评价基于体温保护的护理干预对复杂创伤手术患者的麻醉复苏及皮瓣存活的影响,为复杂创伤手术患者术后康复提供参考。 方法 选取2023年1月—2024年2月就诊于绍兴文理学院附属医院的复杂创伤手术患者152例,采用红蓝球法将患者分为对照组、保温组各76例,对照组采用常规手术室护理,保温组在对照组基础上行基于体温保护的护理干预,比较2组患者核心体温变化、麻醉复苏质量及皮瓣预后差异。 结果 2组患者均成功完成手术。保温组气管插管时、手术开始时、术后30 min时的核心体温均高于对照组,差异有统计学意义(P<0.01),保温组核心体温波动最大时间点为气管插管时。保温组低体温发生率为7.89%(6/76),低于对照组的21.05%(16/76),差异有统计学意义(P<0.05)。保温组患者苏醒时间、麻醉苏醒室停留时间均短于对照组,而术后15 min的Steward苏醒评分高于对照组,差异有统计学意义(P<0.05)。保温组皮瓣完全存活54例、部分存活20例、坏死2例,优于对照组(完全存活40例、部分存活27例、坏死9例),皮瓣弹性恢复时间低于对照组,差异均有统计学意义(P<0.05)。 结论 基于体温保护的护理干预用于复杂创伤手术患者,能够防止和减轻手术中低体温的发生,维持患者体温水平相对平稳,改善术后早期的苏醒质量,缩短苏醒时间,促进术后皮瓣组织的恢复弹性,有利于创伤更快愈合。 Abstract:Objective To evaluate the effect of thermoprotection-based nursing interventions on anaesthesia resuscitation and flap survival in patients undergoing complex trauma surgery, and to provide a reference for postoperative recovery. Methods A total of 152 complex trauma surgery patients were treated at the Affiliated Hospital of Shaoxing University of Arts and Sciences from January 2023 to February 2024 were selected. The patients were divided into two groups using the red and blue ball method: 76 in the control group and 76 in the thermostatic group. The control group received standard operating room care, while the thermostatic group received nursing interventions based on thermoprotection in addition to standard card. The two groups of patients were compared in terms of core temperature changes, anesthesia resuscitation efficiency, and skin flap prognosis. Results The surgeries were successfully completed by both patient groups. The thermostatic group had significantly higher core body temperature during tracheal intubation, at the start of surgery, and 30 minutes after surgery compared to the control group (P < 0.01), with the largest fluctuation occurring during tracheal intubation. The thermostatic group experienced a decreased incidence of hypothermia (7.89%, 6/76) compared to the control group (21.05%, 16/76), with statistically significant difference (P < 0.05). Patients in the thermostatic group woke up earlier and spent less time in the anesthesia recovery room than patients in the control group. At 15 minutes post-operation, the Steward awakening score of the thermostatic group was higher than that of the control group, with statistically significant difference (P < 0.05). Regarding flap survival, the control group had 40 cases of complete flap survival, 27 cases of partial flap survival, and 9 cases of necrosis, while the thermostatic group had 54 cases of complete flap survival and 20 cases of partial flap survival, and 2 cases of necrosis. Additionally, the thermostatic group had a shorter time of flap elasticity recovery than the control group, with statistically significant differences (P < 0.05). Conclusion Thermoprotection-based nursing interventions for patients undergoing complex trauma surgery can prevent and lessen the risk of intraoperative hypothermia, maintain the relatively stable body temperature, enhance early postoperative anesthesia recovery, shorten recovery time, and encourage the restoration of flap tissues elasticity, thereby facilitating faster trauma healing. -
Key words:
- Complex trauma /
- Surgery /
- Temperature protection /
- Flap /
- Resuscitation under anesthesia
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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 data of patients undergoing complex trauma surgery between the two groups
组别 例数 性别(例) 年龄(x±s,岁) BMI(x±s) 致伤原因(例) 手术时间(x±s,min) 术中冲洗液用量(x±s,mL) 成人术中低体温风险评估量表(x±s,分) 男性 女性 交通事故 坠落伤 机器损伤 其他 对照组 76 53 23 51.86±12.34 23.85±2.41 32 16 14 14 94.25±13.17 456.72±35.79 18.23±3.25 保温组 76 56 20 51.93±12.79 23.91±2.52 33 14 12 17 94.73±13.29 458.12±36.91 18.29±3.37 统计量 0.292a 0.034b 0.150b 0.593a 0.224b 0.237b 0.112b P值 0.589 0.973 0.881 0.898 0.823 0.813 0.911 注:a为χ2值,b为t值。 表 2 2组复杂创伤手术患者各时间点体温比较(x±s,℃)
Table 2. Comparison of body temperature at different time points between the two groups of patients undergoing complex trauma surgery(x±s, ℃)
组别 例数 T1 T2 T3 T4 T5 T6 对照组 76 36.32±0.23 36.24±0.20a 36.13±0.18ab 36.29±0.13c 36.30±0.16bc 36.39±0.15abcde 保温组 76 36.35±0.24 36.28±0.21 36.21±0.25a 36.38±0.19bc 36.40±0.25bc 36.41±0.26be F值 0.618 1.234 6.169 13.555 11.972 0.714 P值 0.433 0.205 0.014 <0.001 <0.001 0.399 注:与同组T1比较,aP<0.05;与同组T2比较,bP<0.05;与同组T3比较,cP<0.05;与同组T4比较,dP<0.05;与同组T5比较,eP<0.05。 表 3 2组复杂创伤手术患者麻醉苏醒时间、苏醒室停留时间及Steward苏醒评分比较
Table 3. Comparison of anesthesia recovery time, recovery room residence time, and Steward recovery score between the two groups of patients undergoing complex trauma surgery
组别 例数 苏醒时间(例) 麻醉苏醒室停留时间(x±s,min) Steward苏醒评分(x±s,分) ≤15 min 15~30 min >30 min 术毕15 min 术毕30 min 对照组 76 25 43 11 84.27±21.30 3.82±0.20 4.18±0.40c 保温组 76 41 28 7 60.86±9.79 4.15±0.26 4.26±0.44c 统计量 -2.520a 8.706b 8.770b 1.123d P值 0.012 <0.001 <0.001 0.263 注:与同组术毕15 min比较,cP<0.05;a为Z值,b为t值,d为F值。 表 4 2组复杂创伤手术患者皮瓣预后情况比较(例)
Table 4. Comparison of skin flap prognosis between the two groups of patients undergoing complex trauma surgery(cases)
组别 例数 皮瓣存活情况 皮瓣弹性恢复时间 完全存活 部分存活 坏死 ≤2 s 3~5 s >5 s 对照组 76 40 27 9 14 40 22 保温组 76 54 20 2 42 23 11 Z值 -2.410 -4.620 P值 0.016 <0.001 -
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