国际麻醉学与复苏杂志   2018, Issue (5): 9-9
    
体重指数对腹腔镜妇科手术患者麻醉期间体温的影响及不同保温措施的效果
王卿宇, 李明泽, 马子龙, 邓小明1()
1.潍坊医学院
Influence of body mass index on intraoperative body core temperature in patients undergoing laparoscopic gynecologic surgery and effectiveness of different heat preservation measures
 全文:
摘要:

目的 评价BMI对腹腔镜妇科手术围手术期体温的影响及不同保温措施的有效性。 方法 择期行腹腔镜妇科手术患者60例,根据BMI分层抽样随机将其分为3组(每组20例):正常体重组(N组,BMI 18.5~22.9 kg/m2)、过重组(O组,BMI 23.0~24.9 kg/m2)、轻度肥胖组(L组,BMI 25.0~29.9 kg/m2)。麻醉诱导置入鼻咽温探头10 min后即监测鼻咽温度,记录麻醉诱导后10 min(T1)、30 min(T2)、60 min(T3)、120 min(T4)以及苏醒拔管时(T5)的体温。另选取BMI 18.5~22.9 kg/m2的择期腹腔镜妇科手术患者40例,采用随机数字表法分为2组(每组20例):温液体组(NA组)、温液体+温毯组(NB组)。NA组患者入室后输入预热至37 ℃的加温液体;NB组患者入室前将变温毯预热至37 ℃,入室后即使用,同时入室后输注预热至37 ℃的加温液体,直至患者苏醒拔管。监测与记录指标和方法同前。 结果 N组患者中,T3时体温降低(P<0.05);O组患者中,T4时体温下降(P<0.05);L组患者麻醉诱导后各时间点体温变化差异均无统计学意义(P>0.05)。与N组患者同时间比较,O组T4及T5时体温相对较高(P<0.05),L组T2~T5时体温相对较高(P<0.05)。NA组患者中,T4时体温降低(P<0.05);NB组患者麻醉诱导后各时间点体温变化差异均无统计学意义(P>0.05)。与NA组患者同时间比较,NB组患者T3~T5时体温较高(P<0.05)。 结论 BMI 18.5~22.9 kg/m2的患者在腹腔镜妇科手术中更易发生围手术期低体温,采用预热至37 ℃的温液体,同时使用预热至37 ℃的变温毯覆盖患者上肢及背部两种保温措施能够降低其低体温的发生。

关键词: 体重指数; 核心温度; 低体温
Abstract:

Objective This study aims to evaluate the influence of BMI on intraoperative body core temperature(BcT) in patients undergoing laparoscopic gynecologic surgery and the effectiveness of different heat preservation measures. Methods Sixty women undergoing laparoscopic gynecologic surgery, aged 18-60 with an ASA classification of Ⅰ,Ⅱwere divided into 3 groups according to BMI (n=20): normal weight group (group N, BMI 18.5-22.9 kg/m2), overweight group (group O, BMI 23.0-24.9 kg/m2) and mild obesity group BMI(group L, BMI 25.0-29.9 kg/m2). Nasopharyngeal temperature probe was placed 10 min after anesthesia induction to monitor the BcT. The BcT was recorded at 10 min (T1), 30 min (T2), 60 min (T3), 120 min (T4) after anesthesia induction and at extubation after waking up (T5) respectively. Additionally, 40 women with BMI 18.5-22.9 kg/m2 undergoing elective laparoscopic gynecologic surgery were divided into 2 groups randomly(n=20): warm liquid group (group NA) and warm liquid+warm blanket group(group NB). After patients of group NA entered the operation room, 37 ℃ warm liquid was infused. For patients in group NB, the temperature?蛳adjusting blanket was preheated to 37 ℃ before patients entered the operation room, covering upper limbs and back of patient immediately after the patients entered the operation room. Meanwhile, 37 ℃ warm liquid was infused till patients were woken up and extubated. The BcT and other intraoperative parameters were recorded as the same as stated above. Results BcT of patients in group N were significantly decreased at T3 (P<0.05). Furthermore, for patients in group O, BcT was significantly reduced at T4(P<0.05). For patients in group L, the difference of BcT changes at different time points after anesthesia induction was not statistically significant (P>0.05). Compared to patients in group N at the same time points, BcT of patients in group O at T4 and T5 was relatively high (P<0.05). Patients in group M had higher BcT than group N at T2-T5 time points (P<0.05). BcT of patients in group NA were decreased obviously at T4. For the patients in group NB, there were no differences in BcT at different time points (P>0.05). Compared to subjects in group NA at the same time, BcT of patients in group NB was relatively high at T3-T5 (P<0.05). Conclusions Patients with BMI 18.5-22.9 kg/m2 will easily suffer from intraoperative hypothermia during laparoscopic gynecologic surgery. Infusing warm liquid preheated to 37 ℃ and covering the upper limbs and back with a temperature-adjusting blanket preheated to 37 ℃ can significantly reduce the occurrence of hypothermia.

Key words: Body mass index; Body core temperature; Hypothermia