Zhang Rui, Chen Xueli, Xiao Yan
Department of Operation Room, Liaocheng People's Hospital, Liaocheng, Shandong, China.
Medicine (Baltimore). 2018 Nov;97(45):e13119. doi: 10.1097/MD.0000000000013119.
Perioperative inadvertent hypothermia in elderly urology patients undergoing transurethral resection of the prostate (TURP) is a well-known serious complication, as it increases the risk of myocardial ischemia, blood loss, and surgical wound infection. We conducted this prospective randomized controlled trial to evaluate the combined effect of a forced-air warming system and electric blanket in elderly TURP patients.
Between January 2015 and October 2017, we recruited 443 elderly male patients undergoing elective TURP with subarachnoid blockade (SAB). These were randomly divided into 3 groups: group E (intraoperative warming using electric blankets set to 38°C; n = 128); group F (intraoperative warming using a forced-air warmer set to 38°C; n = 155) and group FE (intraoperative warming using a forced-air warmer plus electric blankets, both set to 38°C; n = 160). The primary outcome was shivering and their grades. Hemodynamic changes, esophageal temperature, recovery time, incidences of adverse effects, and patient and surgeon satisfaction were also recorded.
Baseline characteristics showed no significant differences when compared across the 3 groups (P >.05). Compared with groups E and F, both HR and mean arterial pressure (MAP) in group FE were significantly decreased from T6 to T10 (P <.05). Compared with groups E and F, esophageal temperature in group FE increased significantly from T5 to T10 (P <.05). Compared with group E, esophageal temperature in group F was significantly increased from T5 to T10 (P <.05). Compared with groups F and FE, post-anesthesia care unit (PACU) recovery time was longer in group E, while compared with group F, PACU recovery time was shorter in group FE (P <.05). Compared to patients in groups E and F, those in group FE had a significantly lower incidence of arrhythmia and shivering (P <.05). The number of patients with shivering grades 0 to 3 was higher in group E than in other groups, while the number of patients with shivering grade 2 was significantly higher in group F than in group FE (P <.05). Patient and surgeon satisfaction scores were higher in group FE than in groups E and F (P <.05).
Use of a forced-air warming system combined with an electric blanket was an effective method with which to retain warmth among elderly TURP patients.
接受经尿道前列腺切除术（TURP）的老年泌尿外科患者围手术期意外低温是一种众所周知的严重并发症，因为它会增加心肌缺血、失血和手术伤口感染的风险。我们进行了这项前瞻性随机对照试验，以评估强制空气加热系统和电热毯对老年TURP患者的联合效果。
2015年1月至2017年10月期间，我们招募了443例接受蛛网膜下腔阻滞（SAB）的择期TURP手术的老年男性患者。这些患者被随机分为3组：E组（术中使用设置为38°C的电热毯进行保暖；n = 128）；F组（术中使用设置为38°C的强制空气加热器进行保暖；n = 155）和FE组（术中使用强制空气加热器加电热毯进行保暖，两者均设置为38°C；n = 160）。主要结局是寒战及其分级。还记录了血流动力学变化、食管温度、恢复时间、不良反应发生率以及患者和外科医生的满意度。
3组之间的基线特征比较无显著差异（P >.05）。与E组和F组相比，FE组的心率（HR）和平均动脉压（MAP）在T6至T10时均显著降低（P <.05）。与E组和F组相比，FE组的食管温度在T5至T10时显著升高（P <.05）。与E组相比，F组的食管温度在T5至T10时显著升高（P <.05）。与F组和FE组相比，E组在麻醉后监护病房（PACU）的恢复时间更长，而与F组相比，FE组在PACU的恢复时间更短（P <.05）。与E组和F组的患者相比，FE组患者的心律失常和寒战发生率显著更低（P <.05）。E组中寒战分级为0至3级的患者数量高于其他组，而F组中寒战2级的患者数量显著高于FE组（P <.05）。FE组患者和外科医生的满意度评分高于E组和F组（P <.05）。
使用强制空气加热系统结合电热毯是老年TURP患者保暖的有效方法。
