不同体质量指数老年病人全麻腹腔镜下子宫切除术术中低体温的发生情况

doi:10.3969/j.issn.1003-9198.2023.05.017

摘要/Abstract

摘要： 目的比较不同BMI对全麻腹腔镜下子宫切除老年病人术中低体温、术中出血量、术后感染及苏醒期并发症的影响。方法回顾性分析260例行全麻腹腔镜下子宫切除术的老年病人的临床资料,根据病人的BMI进行分组,其中,BMI<18.5的病人69例(A组),18.5~23.9的病人108例(B组),≥24.0的病人83例(C组)。记录并比较3组病人在T1(进入手术室)、T2(手术30 min)、T3(手术1 h)、T4(手术结束时)时点的体温,以及术中低体温发生情况、术中出血量、术后感染情况及苏醒期并发症发生情况。结果共100例病人发生术中低体温,发生率为38.46%。3组病人在T1、T2时点的体温差异均无统计学意义(P＞0.05),B、C组在T3、T4时点的体温均高于A组(P<0.05),且3组病人在T3、T4时点的体温均低于T1时点(P<0.05)。3组术中出血量＞200 mL、术中低体温、术后感染、苏醒延迟及寒战的发生率差异均有统计学意义(P<0.05),其中A组上述指标的发生率均高于B组、C组。3组苏醒期躁动及拔管后呼吸遗忘的发生率差异均无统计学意义(P＞0.05)。结论 BMI<18.5的全麻腹腔镜下子宫切除老年病人,从手术1 h开始,体温下降更多,术中低体温、术中出血量＞200 mL、术后感染及苏醒期并发症等的发生率更高,应引起关注。

关键词: 体质量指数, 全身麻醉, 腹腔镜下子宫切除, 低体温, 老年人

Abstract: Objective To compare the effects of different body mass index (BMI) on the incidence of intraoperative hypothermia, postoperative infection, complications in the awakening period, and the volume of intraoperative bleeding in the elderly patients undergoing laparoscopic hysterectomy under general anesthesia. Methods The clinical data of 260 elderly patients undergoing laparoscopic hysterectomy under general anesthesia were retrospectively analyzed, and the patients were divided into three groups according to the level of BMI: Group A (BMI<18.5, n=69), Group B (18.5≤BMI≤23.9, n=108) and Group C (BMI≥24.0, n=83). The body temperature of the patients at T1 (entering the operating room), T2 (30 min of operation), T3 (1 h of operation), T4 (at the end of operation), the incidence of intraoperative hypothermia, postoperative infection and complications during the recovery period, and the volume of intraoperative bleeding were recorded and compared. Results Of the 260 elderly patients, 100 patients presented with intraoperative hypothermia (38.46%). There was no significant difference in the body temperature at T1 and T2 among the three groups (P>0.05). The body temperature at T3 and T4 in Group B and Group C was higher than that in Group A (P<0.05), and the body temperature at T3 and T4 in the three groups was higher than that at T1 (P<0.05). There were statistically significant differences in the incidence rates of intraoperative bleeding>200 mL, intraoperative hypothermia, postoperative infection, delayed awakening and chills among the three groups (P<0.05); The above indicators in Group A were higher than those in Group B and Group C. There were no significant differences in the incidence of restlessness during awakening and respiratory amnesia after extubation among the three groups (P>0.05). Conclusions The elderly patients with BMI<18.5 who undergo laparoscopic hysterectomy under general anesthesia have faster temperature drop from the first hour of operation, and the incidence rates of intraoperative hypothermia, intraoperative bleeding>200 mL, postoperative infection and complications during the recovery period are higher.

Key words: body mass index, general anesthesia, laparoscopic hysterectomy, hypothermia, aged

中图分类号:

R 713.42

陈雪, 张晓洁, 饶丽华, 刘纯纯. 不同体质量指数老年病人全麻腹腔镜下子宫切除术术中低体温的发生情况[J]. 实用老年医学, 2023, 37(5): 505-508.

CHEN Xue, ZHANG Xiao-jie, RAO Li-hua,LIU Chun-chun. Occurrence of hypothermia in elderly patients with different body mass index undergoing laparoscopic hysterectomy under general anesthesia[J]. Practical Geriatrics, 2023, 37(5): 505-508.

参考文献

[1] 杨美好, 陈显琴, 林保留, 等. 二氧化碳气腹对腹腔镜手术患者体温的影响[J]. 护理学杂志, 2021, 36(8):31-32.
[2] 董涛. 老年腹部全身麻醉手术患者术中低体温的影响因素[J]. 中国老年学杂志, 2020, 40(6):1228-1230.
[3] 严侠. 多模式保温对老年全髋关节置换术患者低体温、苏醒效果及炎性因子的影响[J]. 浙江创伤外科, 2022, 27(2):284-285.
[4] 渠兴乾, 范之丹. 体重指数对舌颌颈联合根治术患者体温的影响及不同保温方式效果的比较[J]. 中国口腔颌面外科杂志, 2019, 17(5):453-456.
[5] 中华医学会麻醉学分会. 中国麻醉学指南与专家共识[M]. 北京:人民卫生出版社, 2014: 3-25.
[6] 王卿宇, 李明泽, 马子龙. 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[J]. 国际麻醉学与复苏杂志, 2018, 39(5):422-425.
[7] NIEH H C, SU S F. Meta-analysis: effectiveness of forced-air warming for prebention of perioperative hypothenmia in surgical patients[J]. J Adv Nurs, 2016, 72(10):2294-2314.
[8] 马国岭. 腹腔镜全子宫切除术中低体温发生状况及影响因素分析[J]. 中国妇幼保健, 2020, 35(15):2777-2779.
[9] 安晓华, 邱服斌, 高哲慧, 等. 体质指数对腹腔镜全子宫切除术中病人低体温发生率的影响[J]. 护理研究, 2021, 35(12):2242-2244.
[10] SARI S, AKSOY S M, BUT A. The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors[J]. Int J Clin Pract, 2021, 75(6):e14103.
[11] LEE Y, KIM K. Optimal application of forced air warming to prevent peri-operative hypothermia during abdominal surgery: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2021, 18(5):2517.

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