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中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (04) : 298 -302. doi: 10.3877/cma.j.issn.2095-3232.2017.04.014

所属专题: 文献

临床研究

多模式体温干预措施对原位肝移植患者围手术期低体温的影响
张献玲1, 张政2, 罗刚健2, 罗慧3,()   
  1. 1. 510530 广州,中山大学附属第三医院岭南医院外科
    2. 510630 广州,中山大学附属第三医院麻醉科
    3. 510530 广州,中山大学附属第三医院岭南医院手术室
  • 收稿日期:2017-05-10 出版日期:2017-08-10
  • 通信作者: 罗慧
  • 基金资助:
    中山大学附属第三医院护理科研基金(201408)

Effects of multi-modal temperature intervention measures on perioperative hypothermia in patients undergoing orthotopic liver transplantation

Xianling Zhang1, Zheng Zhang2, Gangjian Luo2, Hui Luo3,()   

  1. 1. Department of General Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
    2. Department of Anesthesiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    3. Operating Room, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
  • Received:2017-05-10 Published:2017-08-10
  • Corresponding author: Hui Luo
  • About author:
    Corresponding author:Luo Hui, Email:
引用本文:

张献玲, 张政, 罗刚健, 罗慧. 多模式体温干预措施对原位肝移植患者围手术期低体温的影响[J]. 中华肝脏外科手术学电子杂志, 2017, 06(04): 298-302.

Xianling Zhang, Zheng Zhang, Gangjian Luo, Hui Luo. Effects of multi-modal temperature intervention measures on perioperative hypothermia in patients undergoing orthotopic liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 298-302.

目的

探讨多模式体温干预对肝移植患者围手术期低体温的影响。

方法

本前瞻性研究对象为2014年6月至2016年10月中山大学附属第三医院行原位肝移植术的120例患者。患者均签署知情同意书,符合医学伦理学规定。其中男93例,女27例;年龄31~70岁,中位年龄55岁。采用计算机生成随机数字的方法,将患者按手术时间先后随机分为多模式体温干预组(多模式组,63例)和常规体温组(对照组,57例)。两组患者均在气管插管全身麻醉下行经典非转流原位肝移植术。两组围手术期体温、肝肾功能比较采用独立样本t检验。

结果

多模式组患者无肝期、新肝期4 h、术后72 h体温分别为(34.5±0.7)℃、(35.6±0.7)℃、(36.2±0.8)℃,明显高于对照组的(33.6±0.4)℃、(34.7±0.3)℃、(35.6±0.6)℃(t=6.60,7.24,18.68;P<0.05)。多模式组术后8、16、24 h尿量分别为(72±16)、(77±20)、(77±22) ml/h,明显多于对照组的(50±14)、(52±17)、(60±17) ml/h(t=9.24,13.37,16.79;P<0.05)。多模式组术后8、16、24 h血Scr和PT分别为(80±19)、(92±20)、(115±21)μmol/L和(17.1±2.5)、(17.1±4.0)、(17.1±1.5) s,明显低于对照组的(99±29)、(105±24)、(130±25) μmol/L和(22.6±2.8)、(21.4±3.2)、(19.5±2.3) s (t= -7.29,-11.97,-15.58和-23.21,-11.26,-9.83;P<0.05)。

结论

多模式体温干预能降低肝移植患者围手术期低体温发生率,加速患者术后肝肾功能恢复。

Objective

To investigate the effects of multi-modal temperature intervention measures on perioperative hypothermia in the patients undergoing orthotopic liver transplantation (LT).

Methods

One hundred and twenty patients who underwent orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2014 and October 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 93 cases were males and 27 were females, aged 31-70 years old with a median age of 55 years old. According to the sequencing of the operation time, the patients were randomly divided into the multi-modal temperature intervention group (multi-modal group, n=63) and regular temperature group (control group, n=57) with the method of computer generated random number. All patients in two groups underwent classical non-bypass orthotopic LT under endotracheal general anesthesia. The temperature, liver and renal function during the perioperative period in two groups were compared using independent sample t test.

Results

The temperature at the anhepatic stage, 4 h of reperfusion stage and postoperative 72 h in the multi-modal group was respectively (34.5±0.7)℃, (35.6±0.7)℃ and (36.2±0.8)℃, significantly higher than (33.6±0.4)℃, (34.7±0.3)℃ and (35.6±0.6)℃ in the control group (t=6.60, 7.24, 18.68; P<0.05). The uring volume at postoperative 8, 16 and 24 h in the multi-modal group was respectively (72±16), (77±20) and (77±22) ml/h, significantly more than (50±14), (52±17) and (60±17) ml/h in the control group (t=9.24, 13.37, 16.79; P<0.05). The serum Scr and PT levels at postoperative 8, 16 and 24 h in the multi-modal group were respectively (80±19), (92±20), (115±21) μmol/L and (17.1±2.5), (17.1±4.0) and (17.1±1.5) s, significantly lower than (99±29), (105±24), (130±25) μmol/L and (22.6±2.8), (21.4±3.2), (19.5±2.3) s in the control group (t=-7.29, -11.97, -15.58 and -23.21, -11.26, -9.83; P<0.05).

Conclusions

For the orthotopic LT patients, multi-modal temperature intervention measures can reduce the incidence of perioperative hypothermia and accelerate the recovery of liver and renal function.

表1 多模式组和对照组患者肝移植围手术期体温变化(℃,±s
表2 多模式组和对照组患者肝移植术后各时间点肝肾功能变化(±s
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