充气式加温毯对老年胃癌根治术患者术后体温及炎症因子的影响
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摘要
目的探讨充气式加温毯对老年胃癌根治术患者术后体温及炎症因子的影响。方法便利抽样选择2015年9月至2017年9月符合条件的145例老年胃癌患者为研究对象,随机分为研究组72例和对照组73例。对照组术中给予常规保温法,研究组术中给予充气式加温毯保温,于麻醉前和手术结束后即刻测量鼓膜温度。手术前1 d和手术结束后24 h抽取静脉血检测肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6),并采用简易智力状态检查表(mini-mental state examination,MMSE)进行认知障碍评估。结果研究组20例(27.8%)术后出现低体温,低于对照组(49例,67.1%);研究组术后IL-6、TNF-α水平低于对照组,差异均有统计学意义(P<0.05)。研究组和对照组术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率分别为34.2%(25例)和19.4%(14例),两组比较差异有统计学意义(χ~2=4.039,P=0.044)。结论应用充气式加温毯有助于老年胃癌根治术患者术中体温的稳定性,降低炎症因子水平,并进而降低术后POCD的发生率,值得在临床中进一步推广应用。
Objective To explore the effect of inflatable warming blanket on early postoperative cognitive dysfunction(POCD) and inflammation level in elderly patients with radical gastrectomy.Methods By convenience sampling method,145 eligible elderly patients with gastric cancer from September 2015 to September 2017 were selected and randomly divided into the study group(72 cases) and the control group(73 cases).The control group was given routine heat preservation care during the operation,while the study group was given inflatable warming blanket during the operation.The temperature of tympanic membrane was measured immediately before and after anesthesia.Venous blood was collected for detection of tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) on the first day before operation and 24 h after the operation.Mini-mental state examination was used to assess cognitive impairment.Results In the study group,20 cases(27.8%) had hypothermia after the operation,which was lower than that in the control group(49 cases,67.1%).The levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group(P<0.05).There was 34.2%(25 cases) and 19.4%(14 cases) of POCD in the study group and the control group,respectively.There was significant difference between the two groups(χ~2 = 4.039,P=0.044).Conclusions The application of inflatable warming blanket can reduce the incidence of POCD and the level of inflammatory factors in elderly patients with gastric cancer after radical operation.It is worth further developing in clinical practice.
Objective To explore the effect of inflatable warming blanket on early postoperative cognitive dysfunction(POCD) and inflammation level in elderly patients with radical gastrectomy.Methods By convenience sampling method,145 eligible elderly patients with gastric cancer from September 2015 to September 2017 were selected and randomly divided into the study group(72 cases) and the control group(73 cases).The control group was given routine heat preservation care during the operation,while the study group was given inflatable warming blanket during the operation.The temperature of tympanic membrane was measured immediately before and after anesthesia.Venous blood was collected for detection of tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) on the first day before operation and 24 h after the operation.Mini-mental state examination was used to assess cognitive impairment.Results In the study group,20 cases(27.8%) had hypothermia after the operation,which was lower than that in the control group(49 cases,67.1%).The levels of IL-6 and TNF-α in the study group were significantly lower than those in the control group(P<0.05).There was 34.2%(25 cases) and 19.4%(14 cases) of POCD in the study group and the control group,respectively.There was significant difference between the two groups(χ~2 = 4.039,P=0.044).Conclusions The application of inflatable warming blanket can reduce the incidence of POCD and the level of inflammatory factors in elderly patients with gastric cancer after radical operation.It is worth further developing in clinical practice.
引文
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[12]王晓础,颜小挺,姜晓芬,等.食管癌根治术中综合保温干预对患者术后寒战及炎症应激反应的影响[J].护理与康复,2015,14(2):107-109.
[13]KUREBAYASHI Y,BABA Y,MINOWA A,et al.TGF-β-induced phosphorylation of Akt and Foxo transcription factors negatively regulates induced regulatory T cell differentiation[J].Biochem Biophys Res Commun,2016,480(1):114-119.
[14]孟超,赵亚琴.术中轻度低温对老年患者髋关节置换术后认知功能障碍发生率的影响[J].南通大学学报:医学版,2017,37(2):104-107.
[15]施灵丹.老年脊柱手术后早期认知功能障碍的因素分析[J].浙江创伤外科,2015,20(2):262-264.
[2] 付征,高金贵,张韫辉,等.乌司他丁对老年胃癌患者术后认知功能障碍的影响[J].重庆医学,2015,44(6):777-779.
[3] 郭亮,潘灵辉.老年患者术后认知功能障碍的研究进展[J].中华老年多器官疾病杂志,2017,16(4):317-320.
[4] 李胜云,赵丽丽,李正伟.术前预保温对胃癌根治术患者术中体温变化的影响[J].护理学杂志,2013,28(6):44-46.
[5] 陆燕.肿瘤相关性炎症导致术后认知功能障碍的研究进展[J].中国癌症杂志,2017,27(3):237-240.
[6] 田艳丰,程佳丽,郭淑媛,等.寒冷应激致心肌梗死的发病机制[J].中华心血管病杂志,2013,41(10):890-892.
[7] 冯腾尘.围术期低体温防治研究进展[J].中华实用诊断与治疗杂志,2016,30(3):218-221.
[8] FOLSTEIN M F,FOLSTEIN S E,MCHUGH P R.“Mini-Mental State” a practical method for grading the cognitive state of patients for the clinician [J].J Psychiatr Res,1975,12(3):189-198.
[9] 谭永琼,陈忠兰,廖安鹊.手术患者术中体温变化规律的临床研究[J].华西医学,2015,30(8):1544-1546.
[10]ALDERSON P,CAMPBELL G,SMITH A F,et al.Thermal insulation for preventing inadvertent perioperative hypothermia[J].Cochrane Database Syst Rev,2014,4 (6):166-172.
[11]HORN E P,BEIN B,STEINFATH M,et al.The incidence and prevention of hypothermia in newborn bonding after cesarean delivery:a randomized controlled trial[J].Anesth Analg,2014,118(5):997-1002.
[12]王晓础,颜小挺,姜晓芬,等.食管癌根治术中综合保温干预对患者术后寒战及炎症应激反应的影响[J].护理与康复,2015,14(2):107-109.
[13]KUREBAYASHI Y,BABA Y,MINOWA A,et al.TGF-β-induced phosphorylation of Akt and Foxo transcription factors negatively regulates induced regulatory T cell differentiation[J].Biochem Biophys Res Commun,2016,480(1):114-119.
[14]孟超,赵亚琴.术中轻度低温对老年患者髋关节置换术后认知功能障碍发生率的影响[J].南通大学学报:医学版,2017,37(2):104-107.
[15]施灵丹.老年脊柱手术后早期认知功能障碍的因素分析[J].浙江创伤外科,2015,20(2):262-264.