2018 年第 9 期 第 13 卷

不同保温温度对胃癌手术患者应激反应指标和苏醒时间及脑电双频指数恢复的影响

Effects of different temperatures of heat preservation on stress response, anesthesia recovery and bispectral index in patients undergoing gastric cancer surgery

作者：苗素琴赵玉吕德珍

英文作者：

单位：210000南京军区南京总医院麻醉科

英文单位：

关键词：胃肿瘤；低体温；应激反应；苏醒；保温

英文关键词：

• 摘要：

• 【摘要】目的    对比分析不同保温温度干预措施对胃癌手术患者的应激反应指标和苏醒时间及全身麻醉脑电双频指数（BIS）恢复的影响。方法    选取2015年7月至2017年10月在南京军区南京总医院接受择期胃癌手术治疗的113例患者。根据随机数字表法将患者分成低温组（35例）、高温组（40例）、综合组（38例）。3组采用37 ℃等体温输液联合不同温度保温毯（低温组37 ℃、高温组45 ℃、综合组先45 ℃ 1 h后调至37 ℃）。比较3组患者的基线资料及相关手术指标、不同时点的鼻咽部温度、麻醉结果、苏醒时间、BIS恢复情况及围术期应激反应指标变化。结果    3组患者基线资料差异无统计学意义（P>0.05）。全身麻醉诱导后60 min、120 min及手术结束时高温组、综合组患者鼻咽部温度明显高于低温组，差异有统计学意义（P<0.05）。3组停药时BIS值差异无统计学意义（P>0.05）。综合组患者苏醒时间、停药至BIS≥80所用时间、清醒时间、气管插管时间及麻醉后监测治疗室滞留时间均明显短于低温组、高温组［（17±6）min比（24±8）、（22±8）min，（18±6）min比（28±8）、（26±8）min，（46±7）min比（80±11）、（77±11）min，（24±7）min比（38±8）、（37±8）min，（50±11）min比（83±14）、（81±14）min］，而BIS≥80时丙泊酚效应室浓度明显高于低温组、高温组［（1.21±0.28）mg/L比（0.88±0.36）、（0.92±0.34）mg/L］，差异均有统计学意义（均P<0.05）。3组患者术后C反应蛋白、去甲肾上腺素及肾上腺素水平均明显高于术前，且术后综合组低于低温组、高温组，差异均有统计学意义（均P<0.05）。结论    37 ℃等体温输液联合先45 ℃后37 ℃保温毯综合干预不但可以有效缓解胃癌手术者的应激反应，而且可以缩短全身麻醉后苏醒时间，促进BIS恢复。

• 【Abstract】Objective    To analyze the effects of the different temperatures of heat preservation on stress response, anesthesia recovery time and bispectral index（BIS） in patients undergoing gastric cancer surgery. Methods    From July 2015 to October 2017, 113 patients undergoing elective gastric cancer surgery were enrolled at Nanjing General Hospital of Nanjing Military Region. The patients were randomly divided into low temperature group(n＝35), high temperature group(n＝40) and comprehensive group(n＝38). All patients were treated with 37 ℃ infusion and insulation blankets with different temperatures（low temperature group: 37 ℃; high temperature group: 45 ℃; comprehensive group: 45 ℃ 1 h, 37 ℃）. Baseline medical data and operation records, changes of nasopharyngeal temperature during perioperative period, anesthetic effect, waking time, BIS and stress indicators were analyzed. Results    Baseline information were similar among the three groups(P>0.05). Nasopharyngeal temperatures at 60, 120 min after anesthesia induction and at the end of surgery in high temperature group and comprehensive group were significantly higher than those in low temperature group(P<0.05). BIS after withdrawal of anesthetics showed no significant difference among the three groups(P>0.05). Waking time, time of anesthetic withdrawal to BIS≥80, consciousness recovery time, mechanical ventilation time and postanesthesia intensive care unit residence time in comprehensive group were significantly shorter than those in low temperature group and high temperature group［（17±6）min vs （24±8）,（22±8）min; （18±6）min vs （28±8）,（26±8）min; （46±7）min vs （80±11）,（77±11）min; （24±7）min vs （38±8）,（37±8）min; （50±11）min vs （83±14）,（81±14）min］(P<0.05). Propofol effect-site concentration when BIS≥80 in comprehensive group was significantly higher than that in low temperature group and high temperature group［（1.21±0.28）mg/L vs （0.88±0.36）, （0.92±0.34）mg/L］(P<0.05). After surgery, levels of C-reactive protein, norepinephrine and epinephrine were significantly higher than those before surgery; the levels in comprehensive group were significantly lower than those in low temperature group and high temperature group(P<0.05). Conclusion    In patients undergoing gastric cancer surgery, 37 ℃ constant infusion combined with heat preservation with thermal blanket at 45 ℃ then 37 ℃ can effectively relieve stress, promote anesthesia recovery and BIS recovery.