摘要
目的系统评价复合保温法在老年髋关节置换术患者中的应用效果。方法计算机检索PubMed、Cochrane Library、Embase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网、万方和维普数据库,搜集复合保温法应用于老年髋关节置换术患者的随机对照试验(RCT),实验组在围术期对患者采用≥3种措施进行复合保温,对照组采用常规保温护理措施。检索时限均从建库至2024年11月12日,采用RevMan5.4软件进行Meta分析。结果共纳入16篇RCT文献,包括1272例老年髋关节置换术患者。Meta分析结果显示,与对照组相比,实验组术中保温效果更好(MD=0.31,95%CI:0.25~0.37,P<0.00001),术后低体温发生率低(OR=0.14,95%CI:0.08~0.23,P<0.01)、寒战发生率低(OR=0.14,95%CI:0.10~0.21,P<0.01)、躁动发生率低(OR=0.23,95%CI:0.06~0.84,P=0.03),凝血酶原时间减少(MD=-3.17,95%CI:-5.19~-1.14,P=0.002)、活化部分凝血活酶时间减少(MD=-5.95,95%CI:-9.69~-2.20,P=0.002)、麻醉苏醒时间缩短(MD=-3.96,95%CI:-5.83~-2.08,P<0.0001),CD4^(+)水平升高(MD=2.97,95%CI:2.09~3.85,P<0.01)、CD8^(+)水平降低(MD=-2.30,95%CI:-2.98~-1.62,P<0.01)、CD4^(+)/CD8^(+)水平升高(MD=0.22,95%CI:0.17~0.26,P<0.01),但两组纤维蛋白原比较差异无统计学意义(P=0.17)。结论复合保温法对老年髋关节置换术患者保温效果好,能有效降低术后并发症发生率,对患者的主要凝血功能和免疫功能影响较小,可缩短患者麻醉苏醒时间。
Objective To systematically review the application effect of compound heat preservation in elderly pa⁃tients undergoing hip arthroplasty.Methods PubMed,Cochrane Library,Embase,CINAHL,Web of Science,SinoMed,CNKI,WanFang and VIP databases were electronically searched to collect the randomized controlled trials of compound heat preservation applied to the elderly patients undergoing hip arthroplasty,from inception to November 12,2024.The experimental group used≥3 measures of compound heat preservation for patients during the perioperative peri⁃od,while the control group received conventional insulation nursing measures.A meta-analysis was performed using Rev⁃Man5.4 software.Results A total of 16 RCTs were included in the literature,including 1272 elderly patients undergo⁃ing hip arthroplasty.The results of the meta-analysis showed that,compared with the control group,the experimental group was more effective in intraoperative insulation(MD=0.31,95%CI:0.25-0.37,P<0.00001);low incidence of postoperative hypothermia(OR=0.14,95%CI:0.08-0.23,P<0.01),low incidence of postoperative chills(OR=0.14,95%CI:0.10-0.21,P<0.01),low incidence of postoperative agitation(OR=0.23,95%CI:0.06-0.84,P=0.03);reduced prothrombin time(MD=−3.17,95%CI:−5.19-−1.14,P=0.002),reduced activated partial thromboplastin time(MD=−5.95,95%CI:−9.69-−2.20,P=0.002),shortened anesthesia awakening time(MD=−3.96,95%CI:−5.83-−2.08,P<0.0001);elevated CD4^(+)level(MD=2.97,95%CI:2.09-3.85,P<0.01),decreased CD8^(+)level(MD=−2.30,95%CI:−2.98-−1.62,P<0.01),and elevated CD4^(+)/CD8^(+)level(MD=0.22,95%CI:0.17-0.26,P<0.01).However,the difference was not statistically significant for the fibrinogen(P=0.17).Conclusion The compound heat preservation has a good insulation effect on elderly patients undergoing hip arthroplasty,can effectively reduces the inci⁃dence of postoperative complications,has less impact on patients'major coagulation and immune functions,and shortens the patients'anesthesia awakening time.
作者
王玥琳
蒋运兰
李乐
陈红
王镜
张梦洁
白小雨
武森林
WANG Yuelin;JIANG Yunlan;LI Le;CHEN Hong;WANG Jing;ZHANG Mengjie;BAI Xiaoyu;WU Senlin(School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Party Committee Office,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)
出处
《老年医学研究》
2025年第3期19-25,共7页
Geriatrics Research
关键词
复合保温法
髋关节置换术
低体温
老年人
compound heat preservation
hip arthroplasty
hypothermia
aged
