摘要目的 评价术中保温对老年患者全麻苏醒期谵妄的影响.方法 择期全髋关节置换术的患者80例,年龄≥65岁,性别不限,ASA分级Ⅰ-Ⅲ级,采用电脑随机数字表法分为2组(n=40):常规组(R组)与保温组(W组).C组非手术部位予无菌单包裹,此外不予主动加温措施;W组输入液体加温至37℃,非手术部位用充气保温毯包裹,维持充气保温毯温度38～42℃.于麻醉诱导后5 min(T0)、手术开始后30 min(T1)、60 min(T2)、90 min(T3)、术毕即刻(T4)及麻醉苏醒后30 min(T5)时记录鼓膜温度,计算各时点监测值与入室时监测值的差值(△T).记录术中输液量、手术时间、气管拔管时间、PACU停留时间、PACU期间谵妄和寒战的发生情况.结果 与R组比较,W组T2,3时△T降低,苏醒期谵妄、寒战发生率降低,气管拔管时间及PACU停留时间缩短(P＜0.05).结论 术中保温可降低老年患者全麻苏醒期谵妄的发生,有助于改善麻醉恢复质量.

abstractsObjective To evaluate the effect of intraoperative warming on delirium during emergence from general anesthesia in elderly patients.Methods Eighty elderly patients of both sexes,aged ≥ 65 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective total hip replacement,were assigned to routine group (group R,n=40) and warming group (group W,n=40).The non-operated site was covered using the sterile cloth,and no other active warming measurements were given in group C.Fluid was infused and warmed to 37 ℃,the non-operated site was covered using the forced-air warming system,and the temperature of the forced-air warming system was maintained at 38-42 ℃ in group W.The tympanic membrane temperatures was recorded at 5 min after anesthesia induction,at 30,60 and 90 min after beginning of surgery,at the end of surgery and at 30 min after emergence from anesthesia,and the difference between monitored values and monitored values on admission to operating room (△ T) was recorded at each time point.The intraoperative volume of fluid infused,operation time,extubation time,duration of postanesthesia care unit stay and development of delirium during emergence and shivering were recorded.Results Compared with group R,△T was significantly decreased at 60 and 90 min after beginning of surgery,the incidence of delirium during emergence and shivering was decreased,the extubation time and duration of postanesthesia care unit stay were shortened in group W (P＜0.05).Conclusion Intraoperative warming can decrease the development of delirium during emergence from general anesthesia and is helpful in improving the quality of recovery from anesthesia in elderly patients.