不同灌注液溫度對關節鏡及經尿道攝護腺刮除術病人體溫之影響─系統性回顧與統合分析研究

Effect of different temperature irrigation fluids on patient body temperature in arthroscopic and transurethral resection of prostate surgeries – A systemic review and meta-analysis

李文怡(Wen-Yi Lee)

指導教授 ： 陳建宇

共同指導教授 ： 廖媛美(Yuan-Mei Liao)

臺北醫學大學/護理學院/護理學系碩士暨碩士在職專班/碩士(2016年)

摘要

內視鏡手術使用大量灌注溶液易造成病患的低體溫風險，然而使用加溫灌注液對體溫保護效果至今仍未明確。本研究目的為探討大量灌注溶液溫度對病患體溫及手術過程的影響。透過系統性統合分析，並運用Embase、Pubmed、The cochrane Library等資料庫分別納入關節鏡4篇以及經尿道攝護腺刮除術8篇之隨機分派研究，以統計軟體Review Manager 5.3進行各別文獻統合分析。
結果顯示，相較冷水灌注液，使用溫水於關節鏡手術之血色素下降程度、手術時間及灌注液使用量未有顯著差異，且溫水灌注液能降低寒顫80% (RR=0.2, 95%CI: 0.09-0.45, p<.0001)的相對風險及降低74% (RR=0.26, 95%CI: 0.16-0.41, p<.00001)低體溫的相對風險；且手術60及90分鐘時之平均體溫分別高於冷水組0.27±0.24℃(p= 0.03)及0.46±0.38℃(p= 0.02)，但手術後6小時內的疼痛指數亦高於冷水0.63±0.5分(p=.01)。至於在接受TURP的病人身上，溫水灌注液亦不會影響手術時間、灌注液用量及攝護腺刮除量，且手術後體溫高於冷水組0.64℃±0.32(p=.0001)，寒顫發生風險亦降低79% (RR=0.21, 95%CI: 0.11-0.40, p=.0001)。
本研究為第一個對內視鏡手術運用大量溫水灌注液之統合分析研究，並且證明溫水灌注液對於體溫有明確的助益，但由於目前此類文獻研究品質及數量尚不足夠，因此建議進行研究方法嚴謹的大樣本、多中心之隨機分派研究，才能有更明確的證據應用於臨床，此外對傷口疼痛的差異仍需要有更多資料以便探討是否有類似的併發症。

關鍵字

灌注溶液 ； 溫度 ； 攝護腺肥大刮除術 ； 關節鏡 ； 統合分析

並列摘要

Endoscopic surgery that use copious irrigation fluid could lead to the risk of hypothermia. However, effects of using warmed irrigation fluid are still unclear. The objective of this study is to investigate the effects and influences of copious irrigation fluid temperatures on body temperature. Through a systematic literatures search from data base such as Embase, PubMed, and the Cochrane Library, 4 and 8 random control studies were selected respectively from studies related to arthroscopic, and transurethral resection of prostate procedure, and then used for two separate meta analyses, using statistical software, Review Manager 5.3.
The results indicated that, in comparison with cold irrigation fluid, the use of warm fluid on arthroscopic surgery did not show significant difference on the decreased hemoglobin level, operation time, and amount of irrigation fluid required. However, using warm irrigation fluid reduced relative risk of shivering by 80% (RR=0.2, 95% CI:0.09-0.45, p<.0001), and hypothermia by 74 % (RR=0.26. 95% CI:0.16-0.41, p=<.0001); average body temperatures were higher by 0.27±0.24℃ (p=0.03) and 0.46±0.38℃ (p=0.02), respectively, 60 and 90 minutes after surgery. But, the VAS pain index score 6 hours after surgery was 0.63±0.5 higher than the group using cold irrigation fluid. For patients who were subjected to the TURP procedures, the use of warm irrigation fluid did not affect surgery time, volume of irrigation fluid used, and amount of prostate tissue removed; but body temperature after the surgery was higher than the use of cold irrigation fluid by 0.64℃± 0.32 (p=.0001), and risk of shivery decreased by 79% (RR=0.21, 95% CI: 0.11-0.40, p=.0001).
This study is the first meta-analysis, using data from arthroscopic and TURP surgery irrigated with large amount of warm fluid. It demonstrated that using warm irrigation fluid is an effective method to better maintain body temperature. However, due to the limitation of available studies, both in quality and in quantity, there is insufficient evidence to clearly establish a useful clinical guidance. It is desirable to establish a multi-center research with well controlled random studies to affirm the clinical usefulness of warm irrigation fluid. Furthermore, more information is needed to understand its effects on the pain of surgical wound and its related complications.

並列關鍵字

irrigation fluid, temperature, transurethral resection of prostate procedures, arthroscopic, meta-analysis

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