Study on the application of combined insulation strategy in laparoscopic anatomic hepatectomy in elderly patients

doi:10.3877/cma.j.issn.1674-3946.2023.05.014

Abstract

Abstract:

Objective

To study the effect of composite insulation strategy in the elderly patients undergoing laparoscopic anatomic hepatectomy（LAH）.

Methods

A total of 106 elderly patients with primary liver cancer receiving LAH treatment from January 2021 to April 2023 were randomly divided into control group and observation group，with 53 cases in each group. The control group was subjected to conventional insulation measures，and the observation group was subjected to composite insulation strategies. SPSS 25.0 software was used for data analysis. Measurement data such as perioperative indexes，temperature changes at each time point，stress indexes and immune indexes were represented by（

x ¯

±s），independent t test was performed，and repeated measurement data were analyzed by repeated measurement ANOVA. Intraoperative hypothermia/complications were measured by χ² test. P<0.05 was considered statistically significant.

Results

The body temperature of the observation group was higher than that of the control group from 30min after operation to the end of operation（P<0.05）. The incidence of hypothermia，chills and agitation in the observation group was lower than that in the control group，and the time of recovery after anesthesia，the time of first feeding and the time of postoperative hospitalization were better than those in the control group，with statistical significance（P<0.05）. The levels of tumor necrosis factor-α（TNF-α），interleukin-6（IL-6），C-reactive protein（CRP）and CD8⁺ in observation group were lower than those in control group，and the levels of CD4⁺ and CD4⁺/CD8⁺ were higher than those in control group，with statistical significance（P<0.05）.

Conclusion

The application of composite insulation strategy in laparoscopic anatomic hepatectomy in elderly patients can effectively maintain the temperature stability of patients，reduce stress response，improve the immune function of patients，reduce the occurrence of intraoperative hypothermia and related complications，and facilitate the postoperative rehabilitation of patients.

Key words: Aged, Hepatectomy, Composite insulation strategy, Body Temperature Changes, Stress Response, Immune Function

Tingting Li, Heyu Wu, Yue Zhang, Kang Cheng, Xiaofang Zhang, Yachan Cheng. Study on the application of combined insulation strategy in laparoscopic anatomic hepatectomy in elderly patients[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 522-525.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2023.05.014

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2023/V17/I05/522

Figures/Tables 5

References 15

[1]	叶于富，陈伟，白雪莉. 中国腹腔镜肝癌手术20年演变历程与成就［J/CD］. 中华普外科手术学杂志（电子版），2021，15（04）：363-368.
[2]	张震，郭海云，侯武刚，等. 围手术期低体温研究进展［J］. 解放军医学杂志，2023，48（04）：476-481.
[3]	Öner Cengiz H，Uçar S，Yilmaz M. The Role of Perioperative Hypothermia in the Development of Surgical Site Infection：A Systematic Review［J］. AORN J，2021，113（3）：265-275.
[4]	Yan L，Yao L，Zhao Q，et al. Risk Prediction Models for Inadvertent Intraoperative Hypothermia：A Systematic Review［J］. J Perianesth Nurs，2021，36（6）：724-729.
[5]	Dai J，Li Y. Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy［J］. Comput Math Methods Med，2022，2022：2915157.
[6]	Pu Y，Zhang Y，Tang JJ，et al. Establishment and Validation of a Risk Prediction Model for Intraoperative Hypothermia in Patients Undergoing Laparoscopic Surgery［J］. AORN Journal，2020，112（4）：382.
[7]	吴孟超，汤钊猷，刘允怡，等. 原发性肝癌诊疗规范（2019年版）［J］. 中国实用外科杂志，2020，40（02）：121-138.
[8]	冯涛，詹兴云，林斯锋. 三种不同入路在腹腔镜解剖性肝切除术中的应用价值回顾性分析［J/CD］. 中华普外科手术学杂志（电子版），2022，16（01）：72-75.
[9]	Akers JL，Dupnick AC，Hillman EL，et al. Inadvertent Perioperative Hypothermia Risks and Postoperative Complications：A Retrospective Study［J］. AORN J，2019，109（6）：741-747.
[10]	Hu Y，Tian Y，Zhang M，et al. Study of risk factors for intraoperative hypothermia during pediatric burn surgery［J］. World J Pediatr Surg，2021，4（1）：e000141.
[11]	Liu M，Qi L. The related factors and countermeasures of hypothermia in patients during the anesthesia recovery period［J］. Am J Transl Res，2021，13（4）：3459-3465.
[12]	Hong JX，Fan C，Wei BS. Perioperative nursing principles guided by the concept of enhanced recovery after surgery［J］. Frontiers in Nursing（English），2021，8（1）：1-6.
[13]	林雄坡，刘云肖，马京华，等. 基于专家共识围手术期预防术中低体温护理措施实施现状［J］. 中国医药科学，2023，13（03）：158-161，165.
[14]	Mendonça FT，Ferreira JDS，Guilardi VHF，et al. Prevalence of Inadvertent Perioperative Hypothermia and Associated Factors：A Cross-Sectional Study［J］. Ther Hypothermia Temp Manag，2021，11（4）：208-215.
[15]	Frias AB，Boi SK，Lan X，et al. Epigenetic regulation of T cell adaptive immunity［J］. Immunol Rev，2021，300（1）：9-21.

组别	例	年龄 (岁)	性别		BMI (kg/m²)		肿瘤直径 (cm)
组别	例	年龄 (岁)	男/女		BMI (kg/m²)		肿瘤直径 (cm)
对照组	53	69.4±4.4	39/14		21.8±1.4		5.3±0.6
观察组	53	68.9±5.7	34/19		22.1±1.5		5.2±0.7
t/χ²/Z值		0.506	1.100		-1.064		0.790
P值		0.614	0.294		0.290		0.430
组别	例	Child-Pugh分级		ASA分级		合并肝硬化
组别	例	A/B		Ⅰ/Ⅱ级		是/否
对照组	53	47/6		36/17		41/12
观察组	53	49/4		40/13		43/10
t/χ²/Z值		0.442		0.744		0.229
P值		0.506		0.388		0.632

组别	例	年龄 (岁)	性别		BMI (kg/m²)		肿瘤直径 (cm)
组别	例	年龄 (岁)	男/女		BMI (kg/m²)		肿瘤直径 (cm)
对照组	53	69.4±4.4	39/14		21.8±1.4		5.3±0.6
观察组	53	68.9±5.7	34/19		22.1±1.5		5.2±0.7
t/χ²/Z值		0.506	1.100		-1.064		0.790
P值		0.614	0.294		0.290		0.430
组别	例	Child-Pugh分级		ASA分级		合并肝硬化
组别	例	A/B		Ⅰ/Ⅱ级		是/否
对照组	53	47/6		36/17		41/12
观察组	53	49/4		40/13		43/10
t/χ²/Z值		0.442		0.744		0.229
P值		0.506		0.388		0.632

组别	例	手术时间 (min)	术中出血量 (ml)		术后苏醒时间(min)		首次排气时间(d)
对照组	53	223.8±32.9	512.4±41.7		28.6±5.6		2.1±0.3
观察组	53	216.4±27.4	498.8±36.6		20.0±4.3		2.0±0.4
t值		1.258	1.785		8.866		1.456
P值		0.211	0.077		0.000		0.148
组别	例	首次进食时间(d)		首次下床时间(d)		术后住院时间(d)
对照组	53	3.2±0.5		2.6±0.5		15.5±1.1
观察组	53	2.8±0.4		2.5±0.3		12.0±1.0
t值		4.547		1.249		17.140
P值		0.000		0.215		0.000

组别	例	手术时间 (min)	术中出血量 (ml)		术后苏醒时间(min)		首次排气时间(d)
对照组	53	223.8±32.9	512.4±41.7		28.6±5.6		2.1±0.3
观察组	53	216.4±27.4	498.8±36.6		20.0±4.3		2.0±0.4
t值		1.258	1.785		8.866		1.456
P值		0.211	0.077		0.000		0.148
组别	例	首次进食时间(d)		首次下床时间(d)		术后住院时间(d)
对照组	53	3.2±0.5		2.6±0.5		15.5±1.1
观察组	53	2.8±0.4		2.5±0.3		12.0±1.0
t值		4.547		1.249		17.140
P值		0.000		0.215		0.000

组别	例	T0	T1		T2		T3
对照组	53	37.1±0.2	36.6±0.3		36.4±0.2^a		36.2±0.2^a
观察组	53	37.1±0.3	36.6±0.2		36.6±0.3^a		36.5±0.3^a
t值		-	-		-4.038		-6.057
P值		1.000	1.000		0.000		0.000
组别	例	T4		T5		T6
对照组	53	35.9±0.2^a		35.8±0.2^a		35.8±0.2^a
观察组	53	36.4±0.2^a		36.3±0.2^a		36.5±0.3^a
t值		-12.870		-12.867		-14.134
P值		0.000		0.000		0.000

Please choose a citation manager

Content to export