全雅楠

[摘要]目的 探讨保温护理对全身麻醉腹腔镜胆囊切除术（LC）患者手术应激及麻醉复苏的影响。方法 选取2018年3月～2019年9月我院收治的胆囊结石和（或）胆囊炎实施LC 80例患者为研究对象，按照随机数字表法分为两组，每组各40例。对照组实施常规护理，主要遵医行为为主;观察组则实施本研究保温护理，比较两组麻醉复苏期间（麻醉停止时、进入复苏室时及进入复苏室15 min）体温测定结果;比较两组麻醉苏醒时应激相关因子变化情况;比较两组麻醉苏醒相关指标：呼之睁眼时间、麻醉机辅助通气时间、拔除气管导管时间及复苏室停留总时间;比较两组麻醉复苏期间（麻醉停止时、进入复苏室时及进入复苏室15 min）麻醉苏醒镇静评分标准（Ramsay）变化趋势。结果 观察组麻醉停止时、进入复苏室时及进入复苏室15 min体温高于对照组，差异有统计学意义（P<0.05），麻醉复苏时应激相关因子丙二醛（MDA）低于对照组，差异有统计学意义（P<0.05），超氧化物歧化酶（SOD）水平高于对照组，差异有统计学意义（P<0.05），观察组麻醉苏醒相关指标中呼之睁眼时间、麻醉机辅助通气时间、拔除气管导管时间及复苏室停留总时间短于對照组，差异有统计学意义（P<0.05），麻醉停止时、进入复苏室时及进入复苏室15 min，观察组Ramsay评分高于对照组，差异有统计学意义（P<0.05）。结论 对接受全身麻醉的LC患者，实时保温护理，能有效维持体温稳定，降低应激反应，促进患者麻醉复苏。

[关键词]保温护理;全身麻醉;腹腔镜胆囊切除;手术应激;麻醉复苏

[中图分类号] R473.6          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0234-04

Effect of thermal insulation nursing on surgical stress and anesthesia recovery of patients undergoing laparoscopic cholecystectomy under general anesthesia

QUAN Ya-nan

Department of Emergency， Shenyang Fifth People′s Hospital， Liaoning Province， Shenyang   110023， China

[Abstract] Objective To explore the effect of thermal insulation nursing on surgical stress and anesthesia recovery with undergoing laparoscopic cholecystectomy （LC） under general anesthesia. Methods A total of 80 cases with cholecystolithiasis and/or cholecystitis undergoing LC admitted to our hospital from March 2018 to September 2019 were selected and divided into two groups according to random number table method， 40 cases in each group. The control group implemented routine nursing. The observation group was given the heat preservation nursing， then the body temperature measurement results during anesthesia recovery （when anesthesia stopped， when entering the recovery room and when entering the recovery room for 15 min） were compared. The changes of stress-related factors during anesthesia recovery were compared between the two groups. The related indexes of anesthesia awakening between the two groups were compared： the time of opening eyes， the time of assisted ventilation by anesthesia machine， time of tracheal catheter removal and the total time of stay in resuscitation room. The sedation score standard for anaesthetic awakening （Ramsay） change trend was compared between the two groups during anesthesia recovery period （when anesthesia stopped， when entering the recovery room and when entering the recovery room for 15 min）. Results The body temperature in the observation group was higher than that in the control group （when anesthesia was stopped， when entering the resuscitation room and when entering the resuscitation room for 15 min）， the difference was statistically significant （P<0.05）. The stress-related factor malondialdehyde （MDA） during anesthesia and resuscitation was lower than that of the control group， the difference was statistically significant （P<0.05）， the level of superoxide dismutase （SOD） was  higher than that of the control group， the difference was statistically significant（P<0.05）. In the related indexes of anesthesia recovery， the opening time of eyes， the assistant ventilation time of anesthesia machine， time of extubation and the total stay time in the resuscitation room in the observation group were shorter than those in the control group， the differences were statistically significant （P<0.05）. The Ramsay score in the observation group was  higher than that in the control group （when anesthesia was stopped， when anesthesia entered the resuscitation room and when anesthesia entered the resuscitation room for 15 min）， the difference was statistically significant（P<0.05）. Conclusion For patients undergoing LC under general anesthesia， real-time thermal insulation nursing can effectively maintain body temperature stability and reduce stress response and promote anesthesia recovery.

[Key words] Thermal insulation care; General anesthesia; Laparoscopic cholecystectomy; Surgical stress; Anesthetic sesuscitation

胆囊结石和（或）胆囊炎最有效的方法为手术切除，术后胆囊的胆汁储存功能随时间的推移将被肝内胆管所代偿，对机体胆汁储存能力并不造成负面影响[1]。目前腹腔镜下胆囊切除术（LC）已经成功在各级医院开展[2]。麻醉选择需要配合全身麻醉。接受全身麻醉者，无论手术大小，均可因温度偏低、持续时间过长、皮肤及内脏器官暴露、术中输液等导致机体温度降低[3]，出现低体温而影响体温中枢调节能力，导致术中应激增强，影响术后麻醉苏醒，甚至出现凝血功能障碍等严重并发症而危及患者生命[4]。……