The Effects Of Warmer Fluids Applied To The Patients Undergoing Bilateral Prosthetic Replacement Of Joints

Objective To study the change of body temperature,blood loss,circulation,renal function,serum glucose intraoperatively;shivering,anesthesia recovery period, circulation,immunological stress reaction postoperatively when warm fluid was applied to the patients undergoing selective bilateral prosthetic replacement of joints.And to certify the effects of warm fluid on the body temperature,blood loss,shivering, anesthesia recovery period,circulation,renal function,immunological stress reaction, provide the guide for the warm fluid's intraoperative application.Method Ninety cases of patients who need selective bilateral prosthetic replacement of joints in the operating room which temperature was 22～24℃were divided into two groups randomly,warm group and ambient temperature group,and forty-five patients in each group.Rejecting two patients owing to bilateral prosthetic replacement of joints changed into unilateral prosthetic replacement of joint temporarily,and so on. Forty-four patients in each group finally.The patients in warm group infused with fluid of 36.5～37.5℃,and flushed with fluid of 37℃;when the patients in ambient temperature group infused and flushed with fluid of ambient temperature(22～24℃) intraoperatively.To acquire body temperature and circulation,measure renal function and serum glucose in different intraoperative phases,acquire anesthesia recovery period, shivering and circulation,immunological stress reaction postoperatively.Results1.The NPT of warm group were higher than the other group from the first hour intraoperation(P＜0.05).Its extent of temperature drop was less than the other group at the end of the operation.Its incidence of hypothermia was lower than the ambient temperature group at the same phase from the second hour intraoperation (P＜0.01). 2.The blood loss of warm group was less than the ambient temperature group (P＜0.01).The blood loss of warm group was 611.63±392.31 ml,when the other was 923.42±522.50 ml.3.There was no statistically evident difference in the change of parameters-heart rate, blood pressure,MVO₂ when they were lower in warm group than the other.4.The total volume of urine of warm group is 1046.51±434.30 ml,when the ambient group was 788.16±445.31 ml,difference was significant(P＜0.05).BUN and Cr of warm group were lower than the other group at the same phase,but there was no statistically evident difference.5.Serum glucose of two groups were augment while the operation was kept on,even the incidence of hyperglycemia of warm group was higher than the ambient temperature group from the second hour intraoperation(P＜0.05).6.The incidence of shivering and cold of warm group were lower than the other group postoperatively,the extent of shivering and cold were more serious than the other (P＜0.01).7.The warm group's anesthesia recovery period was shorter than the ambient group (P=0.001).They were 10.42±4.66 min and 17.21±10.63 min relatively.8.There was statistically evident difference in the change of parameters-heart rate, diastolic blood pressure,mean blood pressure,MVO₂ postoperatively when they were lower in warm group than the other group from 10min after operation;systolic blood pressure of warm group were lower than the other group from 30min after operation(P＜0.05).9.The tendencies of IL-6,IL-10,CRP,and Leptin of two groups were same;they reached the high-peak at 24h postoperation.IL-6 and CRP of warm group were lower than ambient temperature group,while its IL-10 and Leptin were higher than ambient temperature group.Excepting statistical difference existed of IL-6 at the end of operation and 48h postoperation,there was no statistically evident difference between two groups in other phases. Conclusion1.Applying warm fluid to patients undergoing bilateral prosthetic replacement of joints intraoperatively can maintain the body temperature steady,reduce the occurrence of hypothermia,cut down the incidences of shivering and uncomfortable of cold,relieve degree of shivering and uncomfortable of cold.2.Applying warm fluid to patients undergoing bilateral prosthetic replacement of joints intraoperatively has some beneficial effects on reducing blood loss,shortening anesthesia recovery period,and maintaining circulation steady during anesthesia recovery stage.3.Applying warm fluid to patients undergoing bilateral prosthetic replacement of joints intraoperatively may have some effects on maintaining normal renal function and homeostasis,ensuring metabolic products to be discharged in time.4.Applying warm fluid to patients undergoing bilateral prosthetic replacement of joints intraoperatively may have some effects on maintaining the level of anti-inflammatory factors,controlling proinflammatory factor on the lower level, slowing down the extent of immunological stress reaction,relieving stress-induced hyperglycemia.