| ObjectiveTo understand the hypothermia rules in patients with primary hepatic carcinoma after hepatectomy.To evaluate effects of individual factors on the rewarming of hypothermic patients in the same treatment regimens,and investigate individual rewarming methods based on the patients’ individual characteristics.MethodsPart Ⅰ:A total of 91 hypothermic patients with primary hepatic carcinoma undergoing operation were analyzed from Aug.2013 to Dec.2013. Gender, age, height, weight, body mass index, body surface area, body surface area/weight, intraoperative blood loss, operative time and tumor diameter factors were processed in single factor analysis, choose the statistically significant factors for multiple factors analysis.PartⅡ:According to the result of Part Ⅰ that body mass index and tumor diameter were the influences on the rewarming of hypothermic patients with primary hepatic carcinoma,the classification standards of Asian BMI and tumor size, the patients were divided into six groups,including A1 group(BMI < 18.5 and tumor diameter≤5cm),A2 group(BMI<18.5 and tumor diameter > 5cm),B1group(BMI:18.5-22.9 and tumor diameter≤ 5cm),B2 group(BMI:18.5-22.9 and tumor diameter>5cm),C1 group(BMI^23.0 and tumor diameter≤5cm),C2group(BM 1≥23.0 and tumor diameter>5cm). The cases of hypothermic patients with primary hepatic carcinoma undergoing operation were analyzed from Jan.2014 to Sep.2014. Based on the analysis of the validity and possibility of the thawing measures,we choose the forced-air blanket and forced-air blanket+electric heating blanket(compound heat preservation) as the intervention measures.The sample size was calculated according to the pre-experiment results.The numbers of A1,A2, B1,B2,C1and C2 are 50,48,60,60,40 and 36 respectively, then they were equally randomized to two intervention groups.We observed the patients’body temperature, anesthesia recovery and postoperation recovery. The data were treated with t test,chi square and repeated measures analysis of variance by SPSS 16.0.ResultsPart I:1. The incidence of postoperation hypothermia was as high as 84.17% in the primary hepatic carcinoma patients.2. The single factor analysis showed that weight, body mass index, body surface area and tumor diameter were statistically significant (P< 0.05),and the multiple factors analysis showed that body mass index and tumor diameter were the influences on the rewarming of hypothermic patients with primary hepatic carcinoma.Part Ⅱ:1. In Group A1,A2,Bland B2, the rewarming rate of compound heat preservation were faster than the forced-air blanket (P<0.05),but in Group C1 and C2,the significant difference were not found (P>0.05)2. The quality of anesthesia recovery:The anesthesia recovery time, spontaneous breathing recovery time and the PACU residence time were shorter in compound heat preservation than the forced-air blanket,the difference in each group was statistically significant (P<0.05). In Group A1,A2,B1 and B2, the incidence of chills were lower than the forced-air blanket,and the patients feel more comfortable (P<0.05),but in Group C1 and C2,the significant difference were not found (P>0.05)3. The recovery of postoperation:In Group A1,A2,Bland B2,abdominal cavity drainage volume on the first postoperative day were less in compound heat preservation than the forced-air blanket, and shorter time of wound healing and less postoperative hospitalization days (P<0.05),but there were no statistically significant difference (P>0.05) in Group C1 and Group C2. There were no statistical significance of the abdominal cavity drainage volume on the second and third opostoperative day,and the wound healing classification also had no statistical significance in each group (P> 0.05)Conclusion1. The incidence of postoperation hypothermia in the primary hepatic carcinoma patients was higher than the reported level of the other general surgery patients.2. The body mass index and tumor diameter can affect the core temperature rising speed in patients with hepatic carcinoma, the core temperature rising speed is in positive correlation with body mass index and in negative correlation with tumor diameter.3. Compound heat preservation can shorten the re warming time in the hepatic carcinoma patients with low or normal BMI, but it’s not obvious in the high BMI patients.4. Compound heat preservation can shorten the anesthesia recovery time, spontaneous breathing recovery time and the PACU residence time, and improve the recovery and comfort of the the low and normal BMI patients with hepatic carcinoma. |
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