主动体温保护对下肢骨折手术凝血功能及出血的影响

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摘要目的分析观察围术期主动体温保护对下肢骨折患者已经激活的凝血功能的影响及出血量的变化。方法纳入80例ASA Ⅰ~Ⅱ级择期行下肢骨折切开复位术的患者，随机分为主动体温保护组和对照组。体温保护组患者进入手术室时，室温设置为26℃，至手术开始调为22℃。3M充气式保温毯覆盖胸腹部，设置其目标体温38℃，保温毯与患者皮肤间用手术单隔开；静脉输液温度37℃，冲洗液温度37℃。对照组予手术巾单覆盖，室温设置为22℃；不使用保暖毯，室温液体输注及冲洗。分别记录两组患者在进入手术室时(T1)、切皮时(T2)、手术开始后1 h(T3)、手术结束后1 h(T4)的耳温，并分别抽取2 mL静脉血行血栓弹力图测定；记录术中失血量及术后36 h引流量以及需输血病例数。结果 a)与体温保护组比较，对照组在手术T4时耳温明显低于主动体温保护组，差异具有统计学意义(P＜0.05)；b)主动体温保护组的出血量和36 h引流量均低于对照组(P＜0.05)；c)与体温保护组相比，T3、T4时对照组纤维蛋白形成时间、血凝块生成时间明显延长，T4时对照组的最大振幅明显缩短，差异有统计学意义(P＜0.05)。结论术中低体温造成下肢骨折患者术中及术后凝血因子活性抑制，血小板功能受限，导致手术失血量和引流量增加，输血概率增加。术中主动体温保护措施对于下肢骨折患者可减少机体热量过度散失，对抗纤溶亢进，减少失血量。

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关键词 ：体温保护, 下肢骨折, 凝血功能, 失血量

Abstract：Objective To observe the effect of active temperature protection on the coagulation function and the change of blood volume in patients with lower limb fracture. Methods 80 cases of ASA Ⅰ~Ⅱ patients with lower limb fractures and open reduction were randomly divided into the active temperature protection group and the control group.The room temperature wass set to 26° when temperature protection groups entered into the operating room，and the temperature had been reset to 22°till surgery starts.3M inflatable thermal insulation blankets covered their chest and the target body temperature was set to 38℃.The blankets were separated from the skin of the patients.Intravenous fluids temperature was 37℃，and rinse fluid temperature was also 37℃.The control group patients were covered with the surgical towel sheet，with room temperature being set to 22℃；thermal blankets were not used，and room temperature liquid were used for infusion and rinse.Auricular temperature of two groups of patients were recorded in the operating room(T1)，tangent(T2)，1h(T3)after the surgery，1h(T4)after the operation.And venous thrombosis were respectively measured.Intraoperative blood loss and 36h drainage were recorded，and the amountr of blood transfusions was recorded.Results a)Compared with the body temperature protection group，the ear temperature of the control group was significantly lower than the active body temperature protection group during operation T4，and the difference was statistically significant(P＜0.05)b)The blooding volume in the active body temperature protection group and drainage volume were lower than those in the control group(P＜0.05)；c)Compared with the body temperature protection group，T3 and T4 were significantly prolonged in the formation of fibroin protein and the time of the formation of blood clots.The maximum amplitude of the control group was significantly shortened in T4，which presents statistical significance.(P＜0.05).Conclusion Low temperature can induce inhibition of blood coagulation factor activity and platelet function in the orthopaedic patients with fracture of lower limb during the intraoperative and postoperative process，which leads to increased blood loss and flow rate as well as an increase in the probability of blood transfusion.Active temperature protection can reduce the body heat loss，decrease fibrinolysis and reduce the blood loss in patients with lower extremity fracture.

Key words： body temperature control lower extremity fracture coagulation blood lose

作者简介: 贾川(1991－ )，男，研究生在读，南京中医药大学，210046。

引用本文:

贾川 1，2，瞿玉兴 2，高益 2，赵洪 2，彭立波 2，徐建达 2. 主动体温保护对下肢骨折手术凝血功能及出血的影响[J]. 实用骨科杂志, 2018, 24(7): 600-604.
Jia Chuan 1，2，Qu Yuxing 2，Gao Yi. Effect of Active Body Temperature Protection on Coagulation Function and Bleeding in Lower Limb Fracture Surgery. sygkzz, 2018, 24(7): 600-604.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I7/600

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