Effect of different temperature of fluids and blood infusion on postoperative recovery quality in elderly patients undergoing total knee arthroplasty / 临床麻醉学杂志

ABSTRACT

Objective To evaluate the clinical effect of different temperature of fluids and blood infusion on postoperative recovery quality in elderly patients undergoing total knee arthroplasty (TKA).Methods One hundred and fifty-six cases of elderly patients (male 42,female 1 14,aged 65-85 years,ASA Ⅰ or Ⅱ)scheduled for selective single TKA were recruited and divided into three groups randomly(n =52 each),normal temperature group (group NT),constant temperature group (group CT)and warming temperature group (group WT).Patients of group NT were infused with blood or fluids of room temperature (22-24 ℃)and surgical area were flushed with fluid of room tem-perature too.Patients of group CT were infused with blood or fluids of 37 ℃ by heating apparatus and temperature of fluids used to flushing was 37 ℃ too.Otherwise,in group WT,the tempreture of blood and fluids for infusion were kept at 37 ℃ and the surgical area were flushed with fluid of 39 ℃. The nasopharyngeal temperature were recorded on time points of before anesthesia (T0 ),30 min (T1 )and 1 h (T2 )after surgery beginning,30 min (T3 )and 1 h (T4 )after surgery.Time of sponta-neous breathing,time of eye opening on call,time of fully conscious,extubation time and Steward scores of patients were recorded too.And the cognitive function were evaluated by Postoperative Quality Recovery Scale (PQRS)on time points of 1 5 min and 40 min after extubation and the 1,3, 30 d after surgery.Results Compared with T0 ,the nasopharyngeal temperature of three groups were significantly decreased at T1-T4 (P <0.05 or P < 0.01 ).The nasopharyngeal temperature of group CT and group WT were significantly higher than in group NT at T1-T4 (P <0.01).And the nasopha-ryngeal temperature of group WT was significantly higher than in group CT at T4 (P <0.05).Com-pared with group NT,time of eye opening on call and spontaneous breathing in groups CT and WT were significantly shorter (P < 0.01 ).Time of fully conscious in group WT was obviously shorter than in group NT (P <0.01),and the Steward score in group WT was significantly higher than in group NT (P <0.05).Compared with before extubation,the cognitive function scores in all patients at 1 5,40 min after extubation and 1,3,30 d after surgery were increased significantly (P <0.01).The cognitive function scores in group CT and group WT at all time points were significantly higher than that in group NT (P <0.05).And the cognitive function scores in group WT was significantly higher than that in group CT at 30 d after surgery (P <0.05).Conclusion The elderly patients undergoing TKA receiving blood transfusion and infusion at 37 ℃ and flushing the area with fluid at 39 ℃ can prevent the occurrence of hypothermia and improve the postoperative recovery quality and cognitive function recovery.