胸腔镜下肺癌根治患者术中体温变化曲线及对护理的启示

doi:10.3761/j.issn.0254-1769.2022.20.007

摘要/Abstract

摘要：

目的通过研究胸腔镜下肺癌根治手术（video-assisted thoracic surgery,VATS）患者术中不同体温变化曲线对麻醉复苏时长的影响,探讨其对术中体温管理的启示。方法回顾性分析浙江省3所医院2018年1月—2020年9月VATS患者的诊疗数据,绘制VATS患者术中不同的体温变化曲线,比较不同曲线对麻醉复苏时长的影响。结果经过筛选,有894例患者数据纳入研究,依据术中体温变化曲线的不同,分成低体温未回升组（281例）、低体温回升组（346例）和正常体温组（267例）。3组的年龄、性别、体重、手术时间、麻醉时间、输液量、出血量、尿量与术中体温变化的速率比较,差异无统计学意义（P>0.05）。低体温未回升组与其他两组的麻醉复苏时长比较,差异有统计学意义（P<0.001）;其他两组的麻醉复苏时长比较,差异无统计学意义（P>0.05）。结论 VATS患者术中体温随手术时间的延长而降低;术中给予VATS患者及时、有效的加温干预可预防发生术中低体温,维持患者手术后正常体温能缩短其术后的麻醉复苏时间,促进其快速康复。

关键词: 肺癌, 手术, 麻醉, 体温, 围手术期护理

Abstract:

Objective To study the influence of different temperature change curves on the duration of anesthesia and resuscitation in patients undergoing video-assisted thoracic surgery（VATS） for lung cancer,and to explore its implications for intraoperative temperature management and nursing,so as to provide evidence-based bases for clinical prevention of hypothermia and rapid rehabilitation. Methods The diagnosis and treatment data of VATS patients in 3 large hospitals in a province from January 2018 to September 2020 were retrospectively analyzed,and different intraoperative body temperature change curves of VATS patients were drawn. The effects of different curves on the duration of anesthesia resuscitation were compared. Results After screening,894 patients were included in the study. According to the different body temperature change curves during operation,they were divided into a “hypothermia without rising group”（281 cases）,a “hypothermia rising group”（346 cases） and a “normal temperature group”（267 cases）. The personal factors（age,gender,weight）,anesthesia and operation factors （operation time,anesthesia time,infusion volume,bleeding volume,urine volume） and the rate（trend） of intraoperative body temperature change in VATS patients were not statistically significant（P>0.05）. There were differences in the duration of anesthesia and resuscitation between the hypothermia without rising group and the other 2 groups（P<0.001）. There was no significant difference in the duration of anesthesia and resuscitation between the other 2 groups（P>0.05）. Conclusion The intraoperative body temperature of VATS patients decreased with the increase of operation time;timely and effective warming intervention given to VATS patients during the operation can prevent the occurrence of intraoperative hypothermia,maintain the normal body temperature after the operation,shorten the postoperative anesthesia recovery time and promote their rapid recovery.

Key words: Lung Cancer, Operation, Anesthesia, Body Temperature, Perioperative Nursing

黄立峰, 钱维明, 徐琴, 朱秋燕, 陈笑笑. 胸腔镜下肺癌根治患者术中体温变化曲线及对护理的启示[J]. 中华护理杂志, 2022, 57(20): 2481-2486.

HUANG Lifeng, QIAN Weiming, XU Qin, ZHU Qiuyan, CHEN Xiaoxiao. Enlightenment of temperature change curve on temperature management and nursing care of patients undergoing video-assisted thoracic surgery of lung cancer[J]. Chinese Journal of Nursing, 2022, 57(20): 2481-2486.

图/表 5

表1 3所医院患者基本资料比较

Table 1 Comparison of basic data of patients in 3 hospitals

图1 胸腔镜下肺癌根治手术患者的术中体温变化曲线注：A为低体温未回升组,B为低体温回升组,C为体温正常组。

Figure 1 Temperature change curve of patients undergoing video-assisted thoracic surgery of lung cancer

表2 3组不同体温变化曲线患者的基本资料比较

Table 2 Basic data of patients with different body temperature curves in 3 groups

表3 各因素对于胸腔镜下肺癌根治手术患者术中体温变化速率的影响（n=281）

Table 3 Effects of various factors on intraoperative temperature change rate in VATS patients（n=281）

表4 3组不同体温变化对其麻醉复苏时长的影响（min,$\bar{x}±s$）

Table 4 Effects of 3 groups different body temperature changes on the duration of anesthesia and resuscitation （min,$\bar{x}±s$）

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