| Objectives:To investigate the optimal warming method of TURP, the candidates received warm fluid irrigating, forced air warming blanket warming, and combination of these two. Body temperature and incidence of shiver were detected. Vital signs and other discomforts(e.g. vomiting and muscular pain) were recorded. The condition of myocardial oxygen consumption was also analyzed.Methods:Ninety patients(ASA I~II level, aged in 50~70 years), scheduled for TURP under combined spinal epidural anesthesia(CSEA), were recruited. They were randomly divided into three groups(n=30 each): group A(warming irrigating fluid group), group B(forced air warming blanket group) and group C(irrigating fluid combined with forced air warming blanket group). In group A, irrigating fluid was placed in the adjustable thermostat water tank, and temperature was set at 35℃~37℃. The upper body sites were covered by common quilts of operate room; In group B, the upper body was covered by inflatable warming blanket, and irrigating fluid was placed 60 minutes(min) at room temperature before the operation; In group C, inflatable warming blanket and warming irrigating fluid(35℃~37℃) were both employed.Axillary temperature and nasopharyngeal temperature of each group were recorded at the following ten points: at ward(T1), entering into operate room(T2), 5 min after CSEA(T3), 10 min after CSEA(T4), irrigating for 10 min(T5), irrigating for 30 min(T6), irrigating for 60 min(T7), irrigating for 90 min(T8), stopping irrigation(T9), and at the end of operation(T10). The incidence of shiver was recorded, and the severity of shiver was assessed. Vital signs [heart rate(HR), mean arterial pressure(MAP) and pulse oxygen saturation(SPO2)] were monitored at each time point above. Vomiting and muscular pain were recorded. Myocardial oxygen consumption was also evaluated.Results:1. Effects of three warming methods on body temperature and shiver of TURP cases:There is significant difference of nasopharyngeal temperature among each group(P<0.05). Generally, significant difference of group A and group C was observed at each time point(P<0.05), meanwhile, no significant difference of group A and group B was found at some time point(P>0.05); Compared with group B and group C, the incidence of shiver in group A was much higher(P<0.05). Shivering was much severer in group A than other groups(P<0.05).2. Effects of three warming methods on vital signs:From the time of anesthesia to the time of patients left operate room, group C, the fluctuation range of vital signs(HR, MAP and SPO2) was less than group A and group B（P＜0.05）.3. Effects of three warming methods on the incidence of vomiting and muscular pain:As the incidence of vomiting, there was significant difference among three group(P<0.05), meanwhile, there was no significant differences between group B and group C(P>0.05); As the incidence of muscular pain, there was no significant difference between group A and group B(P>0.05), while much less in group C than that in group A and group B(P<0.05).4. Effects of three warming methods on myocardial oxygen consumption: As the level of myocardial oxygen consumption, there was significant difference among three group(P<0.05). Myocardial oxygen consumption was highest in group A, followed by group B, and lowest in groupConclusions:There is no significant difference of irrigating fluid warming and forced air warming to prevent hypothermia and shiver during TURP; Combination of these two warming methods may reduce the incidence of shiver and hypothermia, relieve patient’s discomfort, and decrease myocardial oxygen consumption. It was proved to be effective, and deserved further application in clinical practice. |
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