| Objective:In order to observe the protective effect of active warming on patients’intraoperative core body temperature,and to explore the effect of active warming on patients’postoperative recovery and immune function,forced-air warming blanket was used for the elderly undergoing radical resection of colorectal cancer.Methods:Eighty elderly patients undergoing radical resection of colorectal cancer were enrolled and all patients were divided into a warming group（group T）or a control group（group C）depending on whether forced-air warming blanket was used.General information of the patients was collected preoperatively,including gender,age,height,weight,body mass index（BMI）and ASA grade.Vital signs of patients in different time were monitored and recorded,including:systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）and temperature（T）,these moments including:before anesthesia（t0）,at the beginning of the operation（t1）,30 minutes after the beginning of operation（t2）,60 min after the beginning of operation（t3）,90 min after the beginning of operation（t4）,120 min after the beginning of operation（t5）,150 min after the beginning of operation（t6）and the end of anesthesia（t7）.At the same time,the patient’s awakening time,anesthesia time and operation time were observed and recorded after the operation.Postoperative complications,including shivering,intestinal obstruction,anastomotic bleeding,anastomotic fistula,wound infection,pulmonary infection and urinary retention,were observed and recorded.The indicators related to postoperative recovery were observed and recorded,including the first postoperative exhaust time,the first time of water intake,the time of first feeding after the operation,the first time of getting out of bed and the time of postoperative hospital stay.One day prior and after surgery,immune cell content were collected,including white blood cell count（WBC）,neutrophil percentage（NE%）,neutrophil count（NE）,lymphocyte percentage（LY%）,lymphocyte count（LY）,monocyte percentage（MONO%）and monocyte count（MONO）.Peripheral blood was collected before anesthesia（t0）,at the first day after surgery（t8）,at the third day after surgery（t9）and at the seventh day after surgery(t10).After centrifugation at3000 r/min for 10 min,serum was collected and stored in a refrigerator at-20℃.The contents of IL-17,IL-6 and TGF-βin serum were detected by ELISA.Results:（1）Comparisons of general conditions:there were no statistical differences in gender,age,height,weight,body mass index,ASA grade,anesthesia time and operation time between the two groups（P>0.05）.（2）Comparisons of core body temperature and hemodynamics:There were no significant difference in average body temperature between the two groups at t0and t1,but the average body temperature in group T were significantly higher than group C at t2-t7（P﹤0.05）;In addition,the overall incidence of intraoperative hypothermia in group T was 10%,significantly lower than that in group C（85%,P﹤0.05）,and the incidence of hypothermia in group T was significantly lower than that in group C（P<0.05）at t3-t7;through intra-group comparison,the body temperature of patients in both groups at t1-t7 was lower than that at t0（P<0.05）;However,the average body temperature in group T was always>36℃,while it in group C was<36℃at t4-t7.There were no significant difference in heart rate and blood pressure（including SBP and DBP）between group T and group C from t0 to t7（P>0.05）.（3）Comparisons of postoperative recovery and complications between the two groups:compared with group C,the first postoperative exhaust time（P﹤0.05）,the first postoperative water intake time（P﹤0.05）,the time of first feeding after the operation（P﹤0.05）,the recovery time after anesthesia（P﹤0.05）and the time of postoperative hospital stay were shorter in group T,but there were no significant difference in the first time to get out of bed after surgery（P>0.05）.In addition,the incidence of postoperative shivering in group T was 12.5%,significantly lower than that in group C（57.5%,P﹤0.05）.Except for shivering,the incidence of total complications in group T（35%）,including anastomotic bleeding,anastomotic fistula,wound infection,pulmonary infection,urinary retention,and intestinal obstruction,was significantly lower than that in group C（60%,P﹤0.05）.（4）Comparisons of preoperative and postoperative immune cell content:There were no significant difference in preoperative immune cells content between group T and group C,including WBC,NE,LY,MONO,NE%,NE%and MONO%;Postoperative NE in group T（P﹤0.05）was lower than group C,and postoperative LY（P﹤0.05）and LY%（P﹤0.05）in group T were higher than group C.（5）Preoperative and postoperative levels of IL-17,IL-6and TGF-βin the two groups:There were no significant differences in preoperative levels of IL-17,IL-6,TGF-βand postoperative levels of IL-17 in the two groups;The levels of IL-6 in group T were lower than those in group C on the first day after surgery（P﹤0.05）and the third day after surgery（P﹤0.05）,and the levels of TGF-βin group T were lower than those in group C on the first day after surgery（P﹤0.05）and the third day after surgery（P﹤0.05）,but there were no significant difference between the two groups on 7th day after surgery（P>0.05）.Conclusion:（1）Inoperative temperature protection can effectively improve patients’core body temperature,significantly reduce the incidence of hypothermia,and reduce postoperative shivering reaction.（2）Intraoperative active warming can reduce the incidence of postoperative complications,shorten the postoperative recovery time,reduce the length of postoperative hospital stay,and accelerate the rapid recovery of patients after surgery.（3）Inoperative active warming can effectively regulate the proportion of postoperative immune cells,reduce the release of immunosuppressive factors including IL-6 and TGF-β,and does not increase the content of tumor progressive active factor IL-17,which can effectively reduce postoperative immunosuppression and improve the postoperative immune function of patients. |
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