国际麻醉学与复苏杂志   2017, Issue (3): 0-0
    
输液加温在胸腔镜下颈、胸、腹三切口食管癌根治术中的应用
陈玲, 陶坤明, 王嘉锋, 邓小明, 朱科明1()
1.第二军医大学附属长海医院
Prevention of hypothermia by infusion of warm fluid during thoracoscopic-assisted esophagectomy
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摘要:

【摘要】 目的 本研究将描述胸腔镜联合下颈、胸、腹三切口食管癌根治术患者体温变化的曲线,观察输液加温对患者围手术期核心体温变化的影响。 方法 选择2014年10月至2015年6月在我院行择期食道癌根治术患者50例。输液加温组患者在输液过程中实施加温措施,对照组患者室温下常规输液,观察两组患者术中肛温变化和术后寒战发生率。 结果 整个手术期间的体温波动主要以80 min和200 min为界,分为三个阶段。室温和加温输液组患者分别在麻醉后50 min和200 min出现核心体温值的下降。与室温输液组相比,加温输液组术中核心体温≥36℃占麻醉时间的百分比较高(33.3 % vs. 15.3 %,P = 0.040),且核心体温值下降1℃的时间更长(138.75 ± 68.54 min vs.75.63 ± 33.32 min,P = 0.041)。麻醉结束时,加温输液组患者的体温较室温输液组高(35.48 ± 0.48 ℃ vs. 34.90 ± 0.57℃,P = 0.031),且苏醒期寒战的发生率明显降低。 结论 输液加温可减缓患者麻醉过程中体温下降的速度和幅度,减少麻醉期间低体温的整体时间和寒战发生率,但不改变患者麻醉诱导期的体温再分布过程和术后体温的最低点。

关键词: 输液加温器;食道癌根治术;低体温;寒战
Abstract:

【Abstract】 Objective To describe the core temperature curve and access the effect of infusion of warm fluid in patients receiving thoracoscopic-assisted esophagectomy. Methods Fifty patients undergoing elective thoracoscopic-assisted esophagectomy under general anesthesia were divided into two groups by random number table (n = 25). In the warming group, fluids were infused at 40℃, while in the control group, fluids were infused at room temperature. The intraoperative rectal temperature and the incidence of postoperative shivering were recorded respectively. Results In the control group, the core temperature curve divided into three stages, by time points at 80 min and 200min. Statistically significant decline in core temperature was appeared at 50min and 200min post-anesthesia in control and warming group respectively. Compared with the control group, the overall time of intraoperative core temperature higher than 36℃ was longer in the warming group(33.3 % vs. 15.3 %,P = 0.040). And the time of decline with 1℃ in core temperature was longer in the warming group(138.75 ± 68.54 min vs.75.63 ± 33.32 min,P = 0.041). At the end of anesthesia, the core temperature in warming group was higher than that in the control group (35.48 ± 0.48 ℃ vs. 34.90 ± 0.57℃,P = 0.031). The incidence of postoperative shivering was also lower in warming group. Conclusions Infusion of warm fluids is effective in decreasing the rate and magnitude of the decline in core temperature during surgery, reducing the overall time of hypothermia and the incidence of shivering. But it doesn’t change the redistribution process of core temperature during anesthesia induction and prevent hypothermia at the end of surgery.

Key words: Fluid warmer; Thoracoscopic-assisted esophagectomy; Hypothermia; Postoperative shivering