| Objective: 1.Through cooling for high-heated rats with ice pack,explored the rats’ uncomfortable performance with cold stimulation,monitoring the rectal temperature threshold of chill and studying the influence of chill on body temperature and biochemical indexes.2.To establish the body temperature management method for elderly patients undergoing surgery on the basis of comfort theory,and then evaluate the effects of this method on maintaining the body temperature and improving the comfort of patients.Methods: 1.Animal experiment: A total of 76 fever rats were randomly divided into control group,10 ml ice pack group,20 ml ice pack group and 40 ml ice pack group,19 rats in each group.The rats in each group were introduced with fever by subcutaneous injection with 20% dry yeast solution,and then intraperitoneal injection of 2% sodium pentobarbital at a dose of 40mg/kg was performed.When anesthesia produced effects,rats were correspondingly taken the following measures: the control group has not cooling treatment,the other groups used ice packs to cool the neck and armpit of rats for 30 minutes,the rats in 10 ml ice pack group were used 10 ml ice pack,in the 20 ml ice pack group were used 20 ml ice pack,in the 40 ml ice pack group were used 40 ml ice pack.The rat’s uncomfortable performance were observed and the rectal temperature threshold of chill were monitored during cooling.At the end of the intervention,10 rats from each group were randomly selected for rectal temperature monitoring at each time point,the remaining 9 rats were for aortic blood test Serum CK,LDH,SOD,MDA,NO content.Repeated measurement of variance analysis was used to compare the rectal temperature differences in each group,and the changes of rectal temperature were plotted.One-way analysis of variance(ANOVA)and Kruskal-Wallis H test were used to compare the differences of biochemical parameters in rats.The test level was 0.05.2.Clinical effect evaluation: 160 elderly patients who underwent elective surgery in the gastroenterology department of a three-level hospital in Fuzhou,Fujian Province from March 2017 to October 2017 were conveniently selected.The patients were divided into experimental group and control group by random method,80 cases in each group.In the experimental group,body temperature management based on comfort theory was used,the control group was given routine clinical nursing intervention.Patients were monitored for body temperature,heart rate,blood pressure,and oxygen saturation during the procedure;postoperative chills,thermal comfort and pain were assessed.Statistical analysis were performed by descriptive statistical analysis,t test,chi-square test,Mann-Whitney U test and repeated measurement of variance analysis.Results: 1.Animal experiment(1)Observation during the process of therapeutic hypothermia: the rats in the control group and 10 ml ice pack group did not chill,chills have occurred in the 20 ml ice pack group and 40 ml ice pack group’s rats during cooling.Based on chills performance,chill model can be built as no chills,mild chills,severe chills.No chills: chill was not observed in any part of the body in rats during the process of therapeutic hypothermia;Mild chills: there were vertical hair,head,neck trembling,with or without upper extremity tremor;Severe chills: vertical hair,head,neck,limbs and torso tremor occurred.The threshold of the average rectal temperature of mild chills was 37.25℃,of severe chills was 37.07℃.(2)Comparison of rectal temperature changes: the results of repeated measurements of variance showed that the grouping factors had an effect on the change of rectal temperature,the difference was statistically significant(F = 3.961,P = 0.016);The time factor had an effect on body temperature change(F = 41.721,P = 0.000);There was interaction effect between grouping factors and time factors(F = 8.379,P = 0.000),indicating that anal rectal temperature of rats in each group tended to change with time and the trend of change was different.After intervention,the rectal temperature of the rats in the cold group showed an upward trend,and the rats occurred chills increased faster than the rats without the chills.(3)Biochemical indexes: there was no significant difference in the biochemical indexes(CK,LDH,SOD,MDA,NO)between the control group and the experimental group after intervention(P> 0.05).2.Clinical effect evaluation(1)Comparison of body temperature changes: the results of repeated measurements of variance showed that the grouping factors had an effect on the change of temperature,the difference was statistically significant(F = 17.625,P = 0.000),indicating that body temperature in the two groups varied with grouping factors;The time factor had an effect on body temperature change(F=375.329,P = 0.000),which showed that there was a trend of body temperature changing with time.There was interaction effect between grouping factors and time factors(F = 14.569,P = 0.000),indicating that temperature of patients in each group tended to change with time and the trend of change was different.There were significant differences in body temperature at each time point between the control group and experimental group in the study(P <0.05).The incidence of hypothermia was 49.4% in the control group and 17.9% in the experimental group at the end of the operation,the incidence of hypothermia in the experimental group was significantly lower than that in the control group(χ2 = 17.139,P = 0.000).(2)Physiological indicators comparison: There were no significant differences in systolic blood pressure,diastolic blood pressure and oxygen saturation between the two groups at all time points(P> 0.05),and heart rate at each time point showed significant difference(P <0.05).(3)Chills occurrence: the incidence of chills was 11.69% in the control group and 5.13% in the experimental group.There was no significant difference between the two groups(χ2 = 7.247,P = 0.064).(4)Comparison of thermal comfort: after intervention,the patients’ thermal comfort status in the experimental group and the control group were significantly different(χ2 = 12.910,P = 0.005).(5)Postoperative pain status comparison: there was significant difference in the pain VAS score between the two groups(Z=-3.783,P=0.000),and there was significant difference in the pain degree between the two groups(χ2 = 9.622,P = 0.008).Conclusion: 1.Animal experiment: when the ice pack reached a certain degree with cold stimulation,it will cause great discomfort to the rats.Chills was the most prominent manifestation of their discomfort,and rat models of varying degrees of chills can be constructed according to rat chills performance.Chills have a tremendous thermogenic effect,it will speed up the body temperature rise,and the more severe chills,body temperature rise faster.chills caused by short-term use of cold ice bag will not influence biochemical indicators in rats.2.Clinical effect evaluation: the body temperature management methods based on comfort theory can effectively maintain the patient’s temperature and reduce the incidence of postoperative hypothermia in patients.At the same time,it can effectively improve the patients’ thermal comfort,and reduce postoperative pain.The method is conducive to health care workers for effective temperature management of patients,to improve patients’ comfort in the whole,which can be popularized and applied in the clinical working. |
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