李佳佳 张培丽 饶官华 陈尔英 莫艳祯 李舒涵

[摘要] 目的 探討强化保温护理在老年股骨骨折患者手术室护理中的应用价值。方法  方便选取该院2016年8月—2019年10月收治的老年股骨骨折患者128例，根据随机数字表法分成对照组与观察组各64例。对照组采用常规护理，观察组在对照组基础上采用强化保温护理。观察两组术前、术中30 min、术后即刻、术后60 min的体温变化情况，在保温护理前后采血检测血清皮质醇（Cor）、腺苷脱氨酶（AD）、去甲肾上腺素（NE）水平，观察术后并发症发生率。结果 观察组术中30 min、术后60 min的体温高于术前，且对照组术中30 min、术后即刻的体温低于术前，差异有统计学意义（P<0.05）。观察组术中30 min、术后即刻、术后60 min的体温高于对照组，差异有统计学意义（P<0.05）。两组术后血清Cor、AD以及NE水平高于术前，但观察组仍低于对照组，差异有统计学意义（P<0.05）。观察组低体温、寒战发生率分别为3.13%、12.50%，低于对照组的12.50%、26.56%，差异有统计学意义（χ2=3.095、4.026，P<0.05）。结论 强化保温护理能减轻老年股骨骨折患者的手术应激反应，降低体温、寒战发生率。

[关键词] 保温护理;股骨骨折;手术室护理;应激反应

[Abstract] Objective To explore the application value of intensified thermal insulation nursing in the operating room nursing of elderly patients with femoral fractures. Methods 128 elderly patients with femoral fractures treated in the hospital from August 2016 to October 2019 were convenient selected and divided into control group and observation group with 64 cases each according to the random number table method. The control group was treated with routine nursing， and the observation group was treated with intensified thermal insulation based on the control group. Observe the changes in body temperature before， during， 30 minutes， immediately after surgery， and 60 minutes after surgery in the two groups. Blood samples were taken before and after warming to detect serum cortisol （Cor）， adenosine deaminase （AD）， and norepinephrine （NE） level to observe the incidence of postoperative complications. Results The body temperature in the observation group at 30min and 60min after operation was higher than that before operation， and the temperature in the control group at 30min and immediately after operation was lower than before operation， and the difference was statistically significant （P<0.05）. The body temperature in the observation group at 30 minutes， immediately after surgery and 60 minutes after surgery was higher than that in the control group， and the differences were statistically significant （P<0.05）. The levels of serum Cor， AD， and NE in the two groups were higher than before surgery， but the observation group was still lower than the control group， and the difference was statistically significant （P<0.05）. The incidences of hypothermia and chills in the observation group were 3.13% and 12.50%， which were lower than those in the control group of 12.50% and 26.56%， and the differences were statistically significant （χ2=3.095， 4.026， P<0.05）. Conclusion Intensified thermal nursing can reduce the surgical stress response of elderly patients with femoral fractures， and reduce the incidence of hypothermia and chills.

[Key words] Insulation Nursing; Femoral Fracture; Operating Room Nursing; Stress Response

股骨骨折在老年人中患病率较高，且随着我国人口老龄化进程的加剧，老年股骨骨折的发生率呈不断上升的趋势，原因在于老年人骨脆性增加，钙质流失较多，其平衡性、反应速度和反应准确性均逐渐降低，一旦受到暴力或摔倒极易骨折[1-2]，目前，这类患者主要通过手术促进骨折愈合，但老年患者大多合并基础疾病，身体状况较差[3]。此外，因受手术创伤、麻醉等因素影响，导致患者易发生术中低体温，增加心律不齐、血液灌注不足等并发症危险性，不利于手术顺利实施，也会对手术效果及患者的术后康复造成一定的影响[4]。因此，保温护理对这类患者而言至关重要。为了分析术中保温护理对老年股骨骨折患者体温、应激反应以及并发症的影响，将该院2016年8月—2019年10月收治的128例老年股骨骨折患者为研究对象，致力于提高手术安全性，现报道如下。……