基于结构-过程-结果模式的围术期照护降低骨科麻醉复苏期低体温及应激反应的研究

Research on perioperative care in reducing perioperative hypothermia and stress response during anesthesia recovery in orthopedic patients based on structure-process-outcome model

  • 摘要:
    目的 探讨基于结构-过程-结果(SPO)模式的围术期照护对骨科全麻手术患者麻醉复苏期围术期低体温及应激反应的影响。
    方法 选取130例骨科全麻手术患者为研究对象, 采用分层区组随机化分组法分为对照组与观察组,每组65例,对照组予以常规护理模式,观察组在对照组的护理基础上予以基于SPO模式的围术期照护。比较2组患者术后复苏相关指标(苏醒时间、自主呼吸恢复时间、滞留麻醉恢复室时间),比较2组术后即刻和术后30 min患者的核心体温、循环功能心率(HR)、收缩压(SBP)、舒张压(DBP)、生理应激指标去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor), 比较2组患者麻醉恢复期不良事件(恶心呕吐、呼吸抑制、体温过低)发生率。
    结果 观察组苏醒时间、自主呼吸恢复时间及滞留麻醉恢复室时间及不良事件发生率均低于对照组,差异有统计学意义(P < 0.05)。术后30 min, 观察组患者核心体温高于对照组, 2组患者生理应激指标均高于术后即刻,差异有统计学意义(P < 0.05); 术后30 min, 2组患者HR、SBP、DBP均高于术后即刻,且观察组循环功能指标及生理应激指标均低于对照组,差异有统计学意义(P < 0.05)。
    结论 基于SPO模式的围术期照护能维持骨科全麻手术患者核心体温及循环功能的稳定,同时还能降低应激反应和麻醉不良反应,促进麻醉恢复进程。

     

    Abstract:
    Objective To investigate the effects of perioperative care based on structure-process-outcome (SPO) model on perioperative hypothermia and stress response during anesthesia recovery in patients undergoing orthopedic general anesthesia surgery.
    Methods A total of 130 patients undergoing orthopedic general anesthesia surgery were selected as study subjects. They were randomly divided into control group and observation group using a stratified block randomization method, with 65 patients in each group. The control group received conventional nursing model, while the observation group received perioperative care based on the SPO model in addition to the control group's nursing. The postoperative recovery-related indicators (recovery time, spontaneous breathing recovery time, and retentiontime in the anesthesia recovery room), core body temperature, circulatory functionheart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and physiological stress indicatorsnorepinephrine (NE), epinephrine (E), cortisol (Cor)were compared between the two groups immediately after surgery and 30 minutes postoperatively. The incidence of adverse events (nausea and vomiting, respiratory depression, hypothermia) during anesthesia recovery was also compared between the two groups.
    Results The observation group had shorter recovery time, spontaneous breathing recovery time, and retention time in the anesthesia recovery room, as well as a lower incidence of adverse events compared to the control group (P < 0.05). At 30 minutes postoperatively, the core body temperature of patients in the observation group was higher than that in the control group, and the physiological stress indicators in both groups were higher than those immediately after surgery (P < 0.05). At 30 minutes postoperatively, the HR, SBP, and DBP in both groups were higher than those immediately after surgery, and the circulatory function indicators and physiological stress indicators in the observation group were lower than those in the control group (P < 0.05).
    Conclusion Perioperative care based on the SPO model can maintain the stability of core body temperature and circulatory function in patients undergoing orthopedic general anesthesia surgery, and reduce stress responses and anesthesia-related adverse reactions, thereby promoting the anesthesia recovery process.

     

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