Effect Of Perioperative Warming On Hemostasis In Patients Undergoning Laparoscopic Radical Gastrectomy

Objective: To observe the influence of perioperative warming on blood coagulation function in patients with laparoscopic-assisted radical gastrectomy under general anesthesia.Method: Eighty laparoscopic assisted radical gastrectomy patients with ASA I-II were randomly divided into warming group( group H) and control group( group N), with 40 patients each. The patients were unpremedicated. The lower part of the body was warmed for 30 min before surgery disinfection(temperature was set at 38?). After surgery disinfection warming was continued which covering the neck and shoulders(temperature was set at 43?). The fluid infused during operation was warmed to 37?. The peritoneal lavaged during operation was warmed to 37?. In control group(group N) no warming was provided except cloth wrapped on lower limbs. Tympanic temperature measurement started from arriving the room, before and after induction and every 30 minutes after induction until the end of operation. PT, TT, APTT, FBG, TEG were determined respectively before induction of anesthesia,90 min after induction and180 min after induction. Shiver was recorded in PACU.Result:1. There were no significant differences in gender, age, BMI, operative time,anesthetic time and the amount of fluid infused during operation between two groups(P >0.05).2. There were statistically significant differences in temperatures at different observational time between groups(P<0.05). The tympanic temperatures from T2 to T8 in time period were lower than those at T0, differences in their comparisons have statistical significance(P<0.05), whereas T1 and T0 were generally comparative. No significant difference in core temperatures within T9 and T0 in group H, however, in group N, temperatures at T9 was significantly lower than that of T0 instatistics(P<0.05). In term of the observational time sequence, no statistical significance was found among the T0, T1, and T2 in tympanic temperatures between groups. The tympanic temperatures in group H were higher than those in group N at T3, T4, T5, T6, T7, and T8, which difference has statistical significance(P<0.05).3. There were statistical significant difference in PT, TT, and FBG at different observational time between the two groups(P<0.05). As for the parameters in the intraoperative period, PT was prolonged, TT was shortened, and FBG was decreased, when compared with those in the preoperative period. And yet,variations in APTT among different observational time was generally without statistical significance, as in both group H and group N. As for the fluctuations within the observational time sequence, changes in these parameters were generally unremarkable.4. Patients' characters of TEG were regarded as no statistical difference in the baseline. The intraoperative R was prolonged in group H(P<0.05), rather than in the group N. In comparisons of K, ?, MA, CI, and LY30 within different observational time, two groups did not have statistical significance. At the same time point, each index between two groups has no significant difference.5. Comparing with warming group, the control group has a higher ratio of postoperative chill(P<0.05).Conclusion:1.Perioperative warming can prevent the happening of hypothermia and chills effectively in patients who have undergone laparoscopic radical gastrectomy.2. Perioperative warming has no significant effects on blood coagulation function and TEG parameters in patients who have undergone laparoscopic radical gastrectomy.