前瞻性预防概念下的围术期干预在预防老年开腹胃癌根治术低体温和应激反应的应用效果

Application effects of perioperative interventions under the concept of prospective prevention in preventing hypothermia and stress responses in elderly patients undergoing open radical gastrectomy for gastric cancer

中文关键词: 老年, 胃癌, 根治术, 开腹手术, 围术期, 前瞻性预防, 低体温, 应激反应

英文关键词: elderly  gastric cancer  radical operation  laparotomy  perioperative period  prospective prevention  hypo-thermia  stress response

中文摘要:

      目的 探究前瞻性预防概念下的围术期干预在预防老年开腹胃癌根治术低体温和应激反应的应用效果.方法 回顾性分析2021年3月-2024年10月徐州医科大学附属淮安医院收治的75例老年开腹胃癌根治术患者的病例资料,根据不同的干预方法将患者分为观察组(n=39)和对照组(n=36).对照组采用常规围术期干预,观察组采用前瞻性预防概念下的围术期干预.对比2组围术期各时间点的体温、手术及术后恢复情况(手术时间、清醒时间、拔管时间、尿管留置时间)、生理应激反应[舒张压(DBP)、收缩压(SBP)、心率(HR)、空腹血糖(FBG)]水平、心理应激反应[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估]以及围术期低温、寒冷和寒颤发生情况.结果 观察组麻醉后、腹腔打开、手术结束时、复苏后0.5 h、转回病房时、转回病房后24 h的体温均高于对照组(P＜0.05);观察组手术、清醒、拔管和留置尿管时间均短于对照组(P＜0.05);干预后,2组DBP、SBP、HR水平和SAS、SDS评分均较同组干预前降低(P＜0.05),且观察组上述指标值低于对照组(P＜0.05);2组FBG水平均较同组干预前升高(P＜0.05),但观察组FBG水平低于对照组(P＜0.05).2组围术期低温、寒冷和寒颤发生差异无统计学意义(P＞0.05).结论 前瞻性预防概念下的围术期干预在预防老年开腹手术低体温中具有良好的效果,可促进老年患者康复,并减轻应激反应.

英文摘要:

      Objective To explore the application effects of perioperative interventions under the concept of prospective prevention in preventing hypothermia and stress responses in elderly patients undergoing open radical gastrectomy for gastric cancer.Methods The case data of 75 elderly patients who underwent open radical gastrectomy in Affiliated Huai'an Hospital of Xuzhou Medical University from March 2021 to October 2024 were retrospectively analyzed.According to different interven-tion methods,they were divided into observation group(n=39)and control group(n=36).The control group received rou-tine perioperative intervention,while the observation group received perioperative intervention under the concept of prospective prevention.The body temperature at each time point during perioperative period,operation and postoperative recovery indexes(operation time,waking time,extubation time,catheter indwelling time),physiological stress response[diastolic blood pres-sure(DBP),systolic blood pressure(SBP),heart rate(HR),fasting blood glucose(FBG)]and psychological stress re-sponse[Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)],as well as the incidence of hypothermia,cold and chills,during the perioperative period were compared between the two groups.Results The body temperature values of the observation group at the time after anesthesia,at the time of abdominal cavity opening,at the end of surgery,at 0.5 h after resuscitation,at the time of returning to the ward and at 24 h after returning to the ward were significantly higher than those of the control group(P＜0.05).The operation time,waking time,extubation time,catheter indwelling time of the ob-servation group were significantly shorter than those of the control group(P＜0.05).After intervention,the levels of DBP,SBP and HR and scores of SAS and SDS of both groups were significantly lower than those of the same group before interven-tion,and the observation group was significantly lower than the control group(P＜0.05);the levels of FBG of both groups were significantly higher than those of the same group before intervention,but the observation group was significantly lower than the control group(P＜0.05).There was no significant difference in the incidence of hypothermia,cold and chills,during the perioperative period between the two groups(P＞0.05).Conclusion Perioperative intervention under the concept of pro-spective prevention has a good effect on preventing hypothermia in elderly patients undergoing laparotomy.It can promote the recovery of elderly patients and relieve the stress response.