中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
18期
28-31
,共4页
围手术期医护%老年人%保温%凝血功能
圍手術期醫護%老年人%保溫%凝血功能
위수술기의호%노년인%보온%응혈공능
Perioperative care%Aged%Thermal preservation%Hemostatic function
目的 探讨围手术期保温对行腹腔镜直肠癌根治术老年患者凝血功能的影响.方法 行腹腔镜直肠癌根治术老年患者86例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为对照组(常规方法)和试验组(加用综合性保温方法),每组43例.分别监测和记录两组患者在麻醉前及麻醉后30、60、90 min和术毕时的鼻咽温度；麻醉前,麻醉后30、60、90 min,术毕及术后24、48 h取外周静脉血测定凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血小板计数(PLT)、D-二聚体(DD)、纤维蛋白原(FBG)和血管性血友病因子(vWF).结果 对照组麻醉后30、60、90 min及术毕体温较麻醉前和同期试验组均明显降低[(36.1±0.2)、(36.0±0.1)、(35.7±0.1)、(35.6±0.2)℃比(36.8±0.2)℃和(36.8±0.0)、(36.7±0.1)、(36.7±0.2)、(36.8±0.2)℃],差异均有统计学意义(P＜0.05).对照组麻醉后30、60、90 min和术毕PT、APIT、TT较麻醉前和同期试验组均延长；术毕和术后24、48 h PLT较麻醉前和同期试验组明显降低；对照组术后24、48 h DD和vWF较麻醉前和同期试验组明显升高,FBG较麻醉前和同期试验组明显降低,差异均有统计学意义(P＜0.05).试验组各时间点凝血功能指标比较差异均无统计学意义(P＞0.05).结论 围手术期综合性保温能够部分减轻行腹腔镜直肠癌根治术老年患者术后凝血功能抑制程度,使患者早期康复.
目的 探討圍手術期保溫對行腹腔鏡直腸癌根治術老年患者凝血功能的影響.方法 行腹腔鏡直腸癌根治術老年患者86例,ASA分級Ⅰ～Ⅱ級,按隨機數字錶法分為對照組(常規方法)和試驗組(加用綜閤性保溫方法),每組43例.分彆鑑測和記錄兩組患者在痳醉前及痳醉後30、60、90 min和術畢時的鼻嚥溫度；痳醉前,痳醉後30、60、90 min,術畢及術後24、48 h取外週靜脈血測定凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)、凝血酶時間(TT)、血小闆計數(PLT)、D-二聚體(DD)、纖維蛋白原(FBG)和血管性血友病因子(vWF).結果 對照組痳醉後30、60、90 min及術畢體溫較痳醉前和同期試驗組均明顯降低[(36.1±0.2)、(36.0±0.1)、(35.7±0.1)、(35.6±0.2)℃比(36.8±0.2)℃和(36.8±0.0)、(36.7±0.1)、(36.7±0.2)、(36.8±0.2)℃],差異均有統計學意義(P＜0.05).對照組痳醉後30、60、90 min和術畢PT、APIT、TT較痳醉前和同期試驗組均延長；術畢和術後24、48 h PLT較痳醉前和同期試驗組明顯降低；對照組術後24、48 h DD和vWF較痳醉前和同期試驗組明顯升高,FBG較痳醉前和同期試驗組明顯降低,差異均有統計學意義(P＜0.05).試驗組各時間點凝血功能指標比較差異均無統計學意義(P＞0.05).結論 圍手術期綜閤性保溫能夠部分減輕行腹腔鏡直腸癌根治術老年患者術後凝血功能抑製程度,使患者早期康複.
목적 탐토위수술기보온대행복강경직장암근치술노년환자응혈공능적영향.방법 행복강경직장암근치술노년환자86례,ASA분급Ⅰ～Ⅱ급,안수궤수자표법분위대조조(상규방법)화시험조(가용종합성보온방법),매조43례.분별감측화기록량조환자재마취전급마취후30、60、90 min화술필시적비인온도；마취전,마취후30、60、90 min,술필급술후24、48 h취외주정맥혈측정응혈매원시간(PT)、활화부분응혈활매시간(APTT)、응혈매시간(TT)、혈소판계수(PLT)、D-이취체(DD)、섬유단백원(FBG)화혈관성혈우병인자(vWF).결과 대조조마취후30、60、90 min급술필체온교마취전화동기시험조균명현강저[(36.1±0.2)、(36.0±0.1)、(35.7±0.1)、(35.6±0.2)℃비(36.8±0.2)℃화(36.8±0.0)、(36.7±0.1)、(36.7±0.2)、(36.8±0.2)℃],차이균유통계학의의(P＜0.05).대조조마취후30、60、90 min화술필PT、APIT、TT교마취전화동기시험조균연장；술필화술후24、48 h PLT교마취전화동기시험조명현강저；대조조술후24、48 h DD화vWF교마취전화동기시험조명현승고,FBG교마취전화동기시험조명현강저,차이균유통계학의의(P＜0.05).시험조각시간점응혈공능지표비교차이균무통계학의의(P＞0.05).결론 위수술기종합성보온능구부분감경행복강경직장암근치술노년환자술후응혈공능억제정도,사환자조기강복.
Objective To research the effect of perioperative thermal preservation on hemostatic function in elderly patients with laparoscopic rectal cancer resection.Methods Eighty-six elderly patients with laparoscopic rectal cancer resection with ASA Ⅰ-Ⅱ were randomly divided into control group (43 patients) and test group(43 patients).Control group was given routine operation,test group was given routine operation and thermal preservation.The nose pharynx temperature was monitored and recorded respectively on preanesthesia,30,60,90 min post-anesthesia and after operation.The level of prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),platelets (PLT),D-dimer(DD),fibrinogen (FBG),yon Willebrand factor (vWF) were detected on preanesthesia,30,60,90 min post-anesthesia and 24,48 h post-operation.Results The temperature in control group on 30,60,90 min pest-anesthesia and after operation [(36.1 ± 0.2),(36.0 + 0.1),(35.7 + 0.1),(35.6 ± 0.2) ℃] was significantly lower than that on preanesthesia [(36.8 ± 0.2) ℃] and the same time in test group [(36.8 ± 0.0),(36.7 ± 0.1),(36.7 +0.2),(36.8 ±0.2) ℃] (P ＜0.05).The level of PT,APTT and TT in control group on 30,60,90 min post-anesthesia and after operation were significantly longer than those on preanesthesia and the same time in test group (P ＜0.05).The level of PLT in control group after operation and on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group(P ＜ 0.05).The level of DD and vWF in control group on 24,48 h post-operation were significantly higher than preanesthesia and the same time in test group (P ＜ 0.05).The level of FBG in control group on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group (P ＜ 0.05).The hemostatic function had no significant change in test group (P ＞0.05).Conclusion The perioperative thermal preservation in elderly patients with laparoscopic rectal cancer resection can alleviate hemostatic function suppression and promote recovery.
