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[30分钟预加温对脊髓麻醉下老年全髋关节置换患者核心体温、收缩压、心率、术后寒战及炎症反应的影响:一项随机双盲对照试验]

[The Effects of 30-Minutes of Pre-Warming on Core Body Temperature, Systolic Blood Pressure, Heart Rate, Postoperative Shivering, and Inflammation Response in Elderly Patients with Total Hip Replacement under Spinal Anesthesia: A Randomized Double-blind Controlled Trial].

作者信息

Cheon You Mi, Yoon Haesang

机构信息

Department of Nursing, Gachon University Gil Medical Center, Incheon, Korea.

College of Nursing, Gachon University, Incheon, Korea.

出版信息

J Korean Acad Nurs. 2017 Aug;47(4):456-466. doi: 10.4040/jkan.2017.47.4.456.

Abstract

PURPOSE

This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response.

METHODS

Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming.

RESULTS

Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG (χ²=6.15, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group.

CONCLUSION

Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

摘要

目的

本研究旨在确定在脊髓麻醉下接受全髋关节置换术的手术患者中,术前预热对核心体温(CBT)以及从脊髓麻醉诱导直至术后30分钟的血流动力学的影响。我们的目标是评估术后寒战和炎症反应。

方法

通过知情通知招募了62名手术患者。本研究的数据于2013年1月15日至11月15日在韩国仁川一家拥有1300张床位的大学医院收集。从患者进入麻醉前室到脊髓麻醉诱导后3小时测量CBT、全身血压(SBP)和心率。术后30分钟测量寒战情况。术前、术后1天和2天测量C反应蛋白(CRP)和红细胞沉降率(ESR)。62名患者被随机分配到实验组(EG),该组进行30分钟的术前预热,或对照组(CG),该组不进行术前预热。

结果

对脊髓麻醉诱导至诱导后3小时的CBT分析显示,组和时间之间存在显著交互作用(F = 3.85,p = 0.008)。此外,EG组的寒战发生率低于CG组(χ² = 6.15,p = 0.013)。然而,对SBP、心率、CRP和ESR的分析未显示时间和组之间存在显著交互作用。

结论

术前预热30分钟可有效提高脊髓麻醉诱导后2小时和3小时的CBT。此外,术前预热可有效减少术后寒战。

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