| Objective: With the idea of ERAS popularizing in clinic in recent years,the temperature management of the patients have been the important part of the ERAS in perioperative period.This experiment aims to compare: 1.The effect of forced-air warming to different parts of body on the core temperature of patients during thoracopic surgery for lung cancer in the lateral decubitus position;2.The effect of forced-air warming to different parts of body on the core temperature,the recovery time,the incidence of post-operative shiver and other post-operative complications during the recovery period of anesthesia(PACU).Methods: A total of 60 patients undergoing selective thoracoscopic surgery for lung cancer at the Department of Thoracic Surgery,the Cancer Hospital of Dalian Medical University from Oct.2018 to Jan.2019 were enrolled in this study.All of the patients were randomly divided into three groups: forced-air warming to the upper body(group U),forced-air warming to the lower body(group L)and forced-air warming to the under body(group C).The forced-air warming to the upper body(group U): put the disposable warming blanket on the patient’s occipital bone,the back and the arm avoiding the operative region.Intertwine the blanket with the arm from the bottom up;The forced-air warming to the lower body(group L): put the disposable warming blanket between the crista iliaca and the feet;The forced-air warming to the under body(group C): put thewarming blanket on the cotton bed sheet and make the patient supine on the warming blanket.All of the patients had the 6 to 8-hour fasting before the operation.After entering into the Operating Room,the patient opened the venous pathway,inhaled mask oxygen at 4L/min of oxygen flow rate,monitored the ECG,Bp,SpO2 and BIS.All of the patients were injected Midazolam0.03-0.04mg/kg,Sufentanil0.4-0.8ug/kg,Propofol1-2mg/kg and Cisatracurium0.15-0.2mg/kg to anesthesia induction,they were placed in the bronchial catheter,then connected the anesthesia apparatus for mechanical ventilation and PetCO2 should be kept at 35-45 mmHg.Propofol,Sufentanil and Sevoflurane should be used to maintain anesthesia and Cisatracurium intermittently as required to keep the muscle relax.Connect the warming instrument to the warming blanket and set the temperature at 38 degrees Celsius.If the temperature is below 36 degrees Celsius,set the temperature at 43 degrees Celsius.Use sterilized dressing to cover the other exposed parts of patient during operation,and the postoperative cover method is the same as it. Send the patient into the Post-anesthesia Care Unit(PACU)after the operation,and observe the patient’s awakening time and if there are complications like shivering,restlessness,nausea and vomiting,and postoperative hypoxemia.In addition,record the basic information of the patient,basic temperature and the temperature of the anesthesia induction(T0),every 15 minutes until the operation ends(T2,T3,T4…).Record the temperature when patients enter into the recovery room,the temperature still should be recorded every 15 minutes till they leave the recovery room and the temperature when he leaves the recovery room.At last,record the duration of anesthesia,intraoperative transfusion volume,blood transfusion volume,the amount of the bleeding and the urine volume.Results: It was found that there was no obvious difference of the basic information of patients statistically among the three group(P>0.05).What’s more,After comparing the three groups holistically,it was discovered that the core temperature of the group L patient is from T4 to T14,which was distinctly higher than the group U and the group C,the difference was statistically significant(P<0.05).By comparing the groups in pairs,it was also found that:(1)the average core temperature of the group L patients was from T4 to T14 which was obviously higher than the group C,the difference was statistically significant(P<0.05);(2)the average core temperature of the group L patients is between T6 and T10,which was distinctly higher than the group U,the difference was statistically significant(P<0.05);(3)the average core temperature of the group U patients was from T5 to T10,which was distinctly higher than the group C,the difference was statistically significant(P<0.05).The average core temperature of the group L patients was significantly higher than the group U and the group C when the patients were in the recovery room,in 15 minutes,in 30 minutes and they left the recovery room,the difference was statistically significant(P<0.05).The average core temperature of the group U patients was significantly higher than the group C when they were in the recovery room after 15 minutes,30 minutes and the time when they left there,the difference was statistically significant(P<0.05).Furthermore,there was no significant difference among the three groups in the recovery time(P>0.05).There was no significant difference among the three groups in heart rate,mean arterial pressure and oxygen saturation when they left the recovery room(P>0.05).There was no clear difference among patients of the three groups in transfusion volume,blood transfusion volume,the amount of the bleeding and the urine volume during operation(P>0.05).The shivering incidence of group L was 5.0%.The shivering incidence of group U is25.0%.The shivering incidence of group C was 40.0%,the shivering incidence of group L was obviously lower than the group U and the group C,the difference was statistically significant(P<0.05).The incidence of nausea and vomiting of group L was 5.0%.The incidence of nausea and vomiting of group U was 15.0%.The incidence of nausea and vomiting of group C was 10%,but there was no significant difference among the three groups(P>0.05).The incidence of postoperative hypoxemia in group L was 5.0%.The incidence of postoperative hypoxemia in group U was 0.0%.The incidence of postoperative hypoxemia in group C was 10%,but there was no significant difference among the three groups(P>0.05).The incidence of restlessness in group L was 15.0%.The incidence of restlessness in group U was 20.0%.The incidence of restlessness in group C was 15.0%,but there was no significant difference among the three groups(P>0.05).Conclusion: According to the experiment,it was found that during thoracopic surgery for lung cancer in the lateral decubitus position,relative to the forced-air warming to the upper body and under body,the forced-air warming to the lower body have a better effect on maintaining the core temperature of patients when they are in intraoperative or postoperative period.Besides,the shivering incidence of patients of forced-air warming to lower body is lower. |
PDF Full Text Request