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目的观察曲马多静注联合物理保温预防老年患者经尿道前列腺电切术(trans urethral resection prostate,TURP)围术期低体温发生的临床意义。方法收集本科2014年6月至2015年6月拟行TURP的老年患者75例,年龄60~70(64.58±2.24)岁。采用抽签的方法分为曲马多药物保护组、物理保温组和联合保护组,每组25例。入室心电监护,观察并记录肛温,3组患者均采用腰麻联合硬膜外麻醉。曲马多药物保护组患者给予常规干预,麻醉后静脉给予曲马多1.5 mg/kg稀释后缓慢静注,等渗冲洗液及静脉输液均为室温(22℃),围术期不作任何加温保护。物理保温组等渗冲洗液及静脉输注液体预先加温至38℃,手术床铺设38℃循环水毯,充气加温毯进行体表覆盖。联合保护组患者综合上述两种保护方法。记录3组患者术前(T1)、手术开始即刻(T2)、手术1 h(T3)、手术结束(T4)体温。同时评估患者术后寒战、心律失常发生情况和术后平均住院时间。结果 3组患者术前一般情况及术中输液量和冲洗液量比较差异无统计学意义(P>0.05)。T3、T4时刻,联合保护组体温明显高于其余两组(P<0.05)。单纯物理或者药物保护组患者随手术时间推移,体温呈逐渐下降趋势,T3、T4时刻与术前体温比较有明显差异(P<0.05),而联合保护组患者围术期体温没有明显的波动。联合保护组围手术期的寒战、心律失常发生率低于其他两组,术后平均住院天数也明显低于其他两组(P<0.05)。结论曲马多静注联合物理保温能更有效地避免老年患者TURP术中低体温的发生,并减少寒战、心律失常和尿路感染等并发症发生。
Objective To observe the clinical significance of tramadol intravenous injection combined with physical insulation in the prevention of perioperative hypothermia in elderly patients with transurethral resection of prostate (TURP). Methods Seventy 75 elderly patients, aged from 60 to 70 (64.58 ± 2.24 years) underwent TURP from June 2014 to June 2015. By lottery method is divided into tramadol drug protection group, physical insulation group and the joint protection group, 25 cases in each group. Intracaval ECG monitoring, observation and record of rectal temperature, 3 patients were treated with spinal anesthesia combined with epidural anesthesia. Patients in tramadol group were given routine intervention. After anesthesia, intravenous tramadol 1.5 mg / kg was diluted intravenously for slow intravenous infusion. The isotonic irrigation solution and intravenous fluids were both room temperature (22 ° C), without any warming during perioperative period protection. The isotonic irrigation fluid and intravenous infusion fluid of the physical thermal insulation group were preheated to 38 ° C, and the operating bed was set up with a 38 ° C circulating water blanket and an inflatable warming blanket for body surface coverage. Patients in combination protection group integrated the two protection methods. Three groups of patients were recorded preoperative (T1), the beginning of surgery (T2), surgery 1 h (T3), the end of surgery (T4) body temperature. Simultaneous assessment of postoperative chills, arrhythmia and postoperative average length of stay. Results There were no significant differences between the three groups in the preoperative general situation and intraoperative infusion volume and irrigation volume (P> 0.05). At T3 and T4, the body temperature in the combined protection group was significantly higher than the other two groups (P <0.05). Patients in purely physical or drug protection group showed a gradual downward trend in the duration of operation. There was a significant difference (P <0.05) between T3 and T4 time points and preoperative body temperature, while there was no significant fluctuation in perioperative temperature in patients in combination protection group. Perioperative cholera and arrhythmia in the combined protection group were lower than those in the other two groups, and mean postoperative hospital stay was also significantly lower than the other two groups (P <0.05). Conclusion Tramadol intravenous infusion combined with physical insulation can effectively prevent hypothermia in elderly patients with TURP and reduce complications such as chills, arrhythmias and urinary tract infections.