| Objective:The Internet of Things,wireless temperature sensor,medical heating mattress and big data system were used to construct a perioperative whole-course closed-loop temperature management system,to explore the effectiveness of the system in temperature management of elderly patients undergoing total hip arthroplasty,and to provide a new method and basis for perioperative temperature management.Methods:A total of 120 elderly patients with femoral neck fracture admitted to Chengdu First People’s Hospital from January 2020 to December 2020 were selected.All patients underwent total hip arthroplasty.On the basis of cotton quilt insulation,40 cases were added with perioperative whole-course closed-loop temperature management system(closed-loop group)and 40 cases were added with medical heating pad(heating pad group).40 cases were only used with cotton quilt insulation(quilt group).Wireless temperature sensor(i Thermonitor)was used to measure the patient’s wireless temperature after entering the surgical waiting area,and a nasopharyngeal temperature probe was added to measure the nasopharyngeal temperature from endotracheal intubation to the end of surgery.The wireless temperature at 8 minutes after wearing the wireless temperature sensor(T0),immediately after induction of anesthesia(T1),10 minutes after induction(T2),30 minutes after induction(T3),60 minutes after induction(T4),the end of operation(T5)and 20 minutes after entering the anesthesia recovery room(PACU)(T6)were recorded.The consistency of nasopharyngeal temperature and wireless temperature at T2-T5 in all patients was evaluated by intraclass correlation coefficient(ICC)and Bland-Altman method.The study indicators of thrombin time(TT),prothrombin time(PT)and activated partial thromboplastin time(APTT)were detected and compared preoperative and postoperative among the three groups.The incidence of intraoperative hypothermia,postoperative shivering and surgical site infection(SSI)were compared among the three groups.The study information of extubation time,length of hospital stay and abnormal events related to the use of equipment were recorded and compared among the three groups.Results:1.The value of ICC of nasopharyngeal temperature and wireless temperature at T2-T5 in all patients were 0.764 [95% confidence interval(0.690,0.817)](P< 0.001).The two monitoring methods had high consistency.Bland-Altman method showed that the difference between nasopharyngeal and wireless temperature(nasopharyngeal minus wireless)was(0.09±0.25)℃,the 95% limits of agreement was(-0.41,0.58)℃,and the proportion of difference within ±0.5 ℃ was 93.3%.2.Wireless temperature at different time points in the three groups: The wireless temperature was not statistically different among the three groups at T0(P>0.05).Compared with the heating pad group and the quilt group,the wireless temperature at T1-T6 in the closed-loop group was significantly higher(P<0.05),and the wireless temperatures in the closed-loop group were all within the set target temperature range.There was no statistical difference in wireless temperature between the heating pad group and the quilt group at T1 and T2(P> 0.05).The wireless temperature of heating pad group was significantly higher than that of quilt group at T3-T6(P<0.05).Compared with T0,the wireless temperature at T1 in the closed-loop group was relatively higher(P<0.05),the wireless temperature at T3-T6 in the heating pad group was relatively lower(P<0.05),and the wireless temperature at T2-T6 in the quilt group was relatively lower(P<0.05).Trend of wireless temperature: From entering the surgical waiting area to induction of anesthesia,the wireless temperature in the closed-loop group was on the rise.After induction of anesthesia,the wireless temperature in the three groups was on the decline,among which the closed-loop group and the heating pad group dropped to the lowest point 60 minutes after induction of anesthesia,and then gradually rose and tended to be stable.The quilt group continued to drop until the end of the operation,and gradually rose after entering the PACU.3.Coagulation function in the three groups: The study indicators of preoperative TT,PT and APTT were not statistically significant among the three groups(P>0.05).After operation,there were no significant differences in TT,PT and APTT between the closed-loop group and the heating pad group(P>0.05),which were lower than those of the quilt group(P<0.05).The study indicators of APTT in the closed-loop group and the heating pad group were relatively longer after operation than before(P<0.05).The study indicators of TT,PT and APTT in the quilt group were relatively longer after operation than before(P<0.05).Preoperative and postoperative coagulation indexes were in the normal range in the three groups.4.Incidence of intraoperative hypothermia in the three groups: There were 7 cases(17.5%)in the closed-loop group,13 cases(32.5%)in the heating pad group and 30cases(75.0%)in the quilt group.There was no significant difference in the incidence of intraoperative hypothermia between the closed-loop group and the heating pad group(P>0.05),which was lower than that of the quilt group(P<0.05).5.Incidence of postoperative shivering in the three groups: There were 1 case(2.5%)in the closed-loop group,3 cases(7.5%)in the heating pad group and 13 cases(32.5%)in the quilt group.There was no significant difference in the incidence of postoperative shivering between the closed-loop group and the heating pad group(P>0.05),which was lower than that of the quilt group(P<0.05).6.Incidence of SSI in the three groups: There were 3 cases(7.5%)in the closedloop group,2 cases(5.0%)in the heating pad group and 4 cases(10.0%)in the quilt group.The incidence of SSI was not statistically different among the three groups(P>0.05).7.Extubation time in the three groups: The extubation time was(12.53±3.55)minutes in the closed-loop group,(13.15±3.92)minutes in the heating pad group and(16.60±3.98)minutes in the quilt group.There was no significant difference in the extubation time between the closed-loop group and the heating pad group(P>0.05),which was shorter than that of the quilt group(P<0.05).8.Length of hospital stay in the three groups: The length of hospital stay was(11.53±2.79)day in the closed-loop group,(11.10±2.50)day in the heating pad group and(12.13±3.19)day in the quilt group.The length of hospital stay was not statistically different among all groups(P>0.05).9.Safety analysis: There were no abnormal events related to the use of equipment in this study.Conclusion:1.The wireless temperature obtained by the wireless temperature sensor(i Thermonitor)had a high consistency with the nasopharyngeal temperature.The core temperature of the elderly could be continuously measured by i Thermonitor in total hip arthroplasty.2.The perioperative whole-course closed-loop temperature management system based on Internet of Things can safely and effectively maintain the core temperature of elderly patients undergoing total hip arthroplasty,improve coagulation function,prevent hypothermia and shivering,and promote postoperative rehabilitation. |
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