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基于体温保护的护理干预对复杂创伤手术患者麻醉复苏及皮瓣预后的影响

陈兰萍 鲍映雪 周晓栋 沈国华 邵炫赫 徐智娣

陈兰萍, 鲍映雪, 周晓栋, 沈国华, 邵炫赫, 徐智娣. 基于体温保护的护理干预对复杂创伤手术患者麻醉复苏及皮瓣预后的影响[J]. 中华全科医学, 2024, 22(10): 1795-1799. doi: 10.16766/j.cnki.issn.1674-4152.003736
引用本文: 陈兰萍, 鲍映雪, 周晓栋, 沈国华, 邵炫赫, 徐智娣. 基于体温保护的护理干预对复杂创伤手术患者麻醉复苏及皮瓣预后的影响[J]. 中华全科医学, 2024, 22(10): 1795-1799. doi: 10.16766/j.cnki.issn.1674-4152.003736
CHEN Lanping, BAO Yingxue, ZHOU Xiaodong, SHEN Guohua, SHAO Xuanhe, XU Zhidi. Effect of temperature protection-based nursing intervention on anesthesia resuscitation and flap outcomes in patients undergoing complex trauma surgery[J]. Chinese Journal of General Practice, 2024, 22(10): 1795-1799. doi: 10.16766/j.cnki.issn.1674-4152.003736
Citation: CHEN Lanping, BAO Yingxue, ZHOU Xiaodong, SHEN Guohua, SHAO Xuanhe, XU Zhidi. Effect of temperature protection-based nursing intervention on anesthesia resuscitation and flap outcomes in patients undergoing complex trauma surgery[J]. Chinese Journal of General Practice, 2024, 22(10): 1795-1799. doi: 10.16766/j.cnki.issn.1674-4152.003736

基于体温保护的护理干预对复杂创伤手术患者麻醉复苏及皮瓣预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003736
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 R619

Effect of temperature protection-based nursing intervention on anesthesia resuscitation and flap outcomes in patients undergoing complex trauma surgery

  • 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。

     

  • 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 0.589 0.973 0.881 0.898 0.823 0.813 0.911
    注:a为χ2值,bt值。
    下载: 导出CSV

    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 0.618 1.234 6.169 13.555 11.972 0.714
    P 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。
    下载: 导出CSV

    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 0.012 <0.001 <0.001 0.263
    注:与同组术毕15 min比较,cP<0.05;aZ值,bt值,dF值。
    下载: 导出CSV

    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 -2.410 -4.620
    P 0.016 <0.001
    下载: 导出CSV
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  • 收稿日期:  2024-03-10
  • 网络出版日期:  2024-12-28

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