注册本刊作者作者投稿查稿
专家远程审稿编辑在线审稿
编务办公专区主编办公专区
下载文档
工作动态
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接

当前位置：首页 > 过刊浏览->2010年第8期

围术期体温保护对食管癌根治术患者应激的影响
The efficacy of perioperative temperature protection during radical resection for carcinoma of oesophagus and effects on stress responses

浏览(2553) 下载(0)

DOI:
作者:
邱郁薇，吴镜湘，徐美英
QIU yu-wei, WU jing-xiang，XU Mei-ying.
作者单位:
上海市胸科医院
Shanghai Chest Hospital
关键词:
食管癌根治术；中心温度；儿茶酚胺
radical resection for carcinoma of oesophagus; core temperature; catecholamines
摘要:
摘 要 目的 比较围术期体温保护对食管癌根治术患者的保温效果及摘 要 目的 比较围术期体温保护对食管癌根治术患者的保温效果及对患者应激的影响。 方法 选取择期行食管癌根治术患者36例，ASAⅠ～Ⅱ级，根据术中温度处理措施将患者随机分为常规体温管理组（C组）和充气加温毯保温组（T组），每组各18例。T组患者麻醉诱导前采用充气毯43℃预加热20min并保温直至术毕。观察两组患者麻醉诱导即刻（T1）、诱导后30min（T2）、60min（T3）、120min（T4）、180min（T5）和/或240min（T6）以及术毕（T7）时点鼻咽温度；采用Elisa法测定麻醉诱导前及术毕时点血浆去甲肾上腺素、肾上腺素浓度；采集并分析麻醉诱导后及术毕患者桡动脉血气。结果 两组患者不同时点体温比较存在显著差异（P<0.01）；其变化趋势显示T组各时间点温度变化较为平稳，而C组体温下降较快，在T2-T4时段下降最快，T3以后C组各时点平均温度均低于36℃，而T组各时点温度均大于36℃，且两组患者在T2时点后温度差值进一步增大；组内两两比较，T1、T2时点温度高于其他时间点，T1高于T2，T3以后各时间点无显著差异。C组患者术毕血浆去甲肾上腺素浓度（660.33±89.83ng/m）明显高于麻醉前（598.28±86.87 ng/ml），P<0.01；T组患者术毕血浆去甲肾上腺素浓度（736.46±152.48 ng/ml ）也较麻醉前（721.69±143.72 ng/ml）有所增加，P<0.01；组间比较，C组患者术毕去甲肾上腺素浓度的增高较T组更为显著，P<0.05。术毕两组患者血浆肾上腺素浓度也较麻醉前明显增高，C组术毕为25.14±2.63 ng/ml高于麻醉前22.18±3.43 ng/ml ，T组术毕为25.92±2.95ng/ml高于麻醉前24.79±3.41ng/ml，但两组间比较没有显著性差异，P〉0.05。T组术毕有3例患者发生代谢性酸中毒（发生率为3/17），而C组代谢性酸中毒发生率为10/18，两组比较有显著性差异。结论 术中采用充气毯加温可以给患者提供良好的体温保护，减少围术期低体温的发生；且可以降低血浆儿茶酚胺尤其是去甲肾上腺素升高的幅度，减轻围术期的应激反应。术中保温还可以减少酸中毒的发生，改善围术期患者内环境紊乱。 [关键词] 食管癌根治术；中心温度；儿茶酚胺
The efficacy of perioperative temperature protection during radical resection for carcinoma of oesophagus and effects on stress responses QIU yu-wei, WU jing-xiang，XU Mei-ying. Department of Anesthesiology, Shanghai Chest Hospital affiliated to Shanghai JiaoTong University, 200030, China [Abstract] Objective To investigate the efficacy of perioperative temperature protection during radical resection for carcinoma of oesophagus and effects on stress responses. Methods Thirty-five patients undergoing radical resection for carcinoma of esophagus were randomly assigned to two groups: routine temperature care group (Group C, patients were not warmed intraoperatively, n=18) and perioperative temperature protection group (Group T, patients were prewarmed before anesthesia induction 20 minutes using forced-air warming system until the end of operation, n=17). The temperature of anesthesia induction（T1）、30 minutes (T2)、60minutes（T3）、120 minutes（T4）、 180 minutes (T5)、240 minutes （T6）after induction and the end of operation(T7) were recorded .The plasma concentration of noradrenaline and adrenaline were tested by ELISA Before anesthesia and at the end of operation.The blood gas analysis was performed during anesthesia. Results There were significant differences of nasopharyngeal temperature between two groups at different time points. The incidence of mild hypothermia of Group C was 56% , while the temperature of patients in Group T were all above 36℃ during the operation .At the end of operation, the plasma level of noradrenaline increased from 598.28±86.87 ng/ml to 660.33±89.83 ng/ml in Group C, while there was an increase of noradrenaline from 721.69±143.72 ng/ml to 736.46±152.48 ng/ml in Group T. The increased level of noradrenaline in Group T was less than in Group C. Though the plasma level of adrenaline rised sharply at the end of operation in both groups, there was no significant difference of increased level of adrenaline between groups .The incidence of metabolic acidosis in Group T was less than in Group C. Conclusion Forced-air warming system can effectively maintain normothermia during operation and reduces the incidence of mild hypothermia; Temperature protection can reduce the increased argument of noradrenaline during operation while it may lessen the stress response. Good temperature control also can relieve the disturbance of acid-base equilibrium. [Key words] radical resection for carcinoma of oesophagus; core temperature; catecholamines

 

主管单位：上海市卫生健康委员会  主办单位：上海市医学会
©2024《上海医学》编辑部 沪ICP备09078599号
您是本站第26562138名访问者
网站管理