Discussion On The Prevention Of FGID And DVT By Keeping Feet Warm During And After Total Hysterectomy

Objective:1.To explore how to keep the feet warm at two temperatures during and after laparoscopic and open hysterectomy,by recording the patient’s age,BMI,operation time,intraoperative blood loss,and intraoperative warm saline（35°C）flushing the abdominal cavity,total fluid volume of the operation day,recovery time of bowel sounds,time to first exhaust,incidence of abdominal distension,time to defecation,white blood cell count and percentage of neutrophils on the first postoperative day,blood potassium on the first postoperative day,D-dimer,the content of aggregate and fibrinogen,and by observing the symptoms and signs of the lower extremities and color Doppler ultrasound examination of the veins of the lower extremities,it is analyzed whether keeping the feet warm during and after the operation is beneficial to the recovery of gastrointestinal function and the prevention of DVT in the lower extremities.2.At the same time,discuss the appropriate temperature for keeping the feet warm at the two temperatures during and after the operation,and provide a clinical reference index and guiding value for the recovery of gastrointestinal function and the prevention of lower extremity DVT.Methods:The patients who underwent laparoscopic hysterectomy （134 cases）and the patients who underwent open hysterectomy（100 cases）in the Affiliated Hospital of Qinghai University in the past year were selected.Informed consent of patients must be obtained before research.Patients with laparoscopic hysterectomy in the control group（60 cases）and patients with open hysterectomy in the control group（50 cases）were given routine surgical warmth intervention,including turning on the purifying air-conditioning system 30 minutes before the operation in the operating room to ensure that the operating room is maintained at a temperature of 22°C to 24°C and the humidity is maintained at 40%to 60%during the operation;cover the non-surgical skin area of the patient with a uniform quilt.It may reduce the patient’s exposed area;after the operation,the patient’s body is covered with a uniform quilt and sent to the ward.In the study group,patients with laparoscopic total hysterectomy and open total hysterectomy were combined with warm foot protection measures on the basis of the above-mentioned conventional warm intervention.Patients in the low-grade laparoscopic group（34 cases）were combined with low-grade（30°C）during and after surgery for30 minutes;patients in the high-grade group（40 cases）were combined with high-grade（40°C）during and after surgery for 30 minutes.Patients in the low-grade laparotomy group（20 cases）were combined with low-grade（30°C）during and after surgery for 30 minutes;patients in the high-grade group（30cases）were combined with high-grade（40°C）during and after surgery for 30minutes.Results:1.Comparison of age and BMI between the general data in the control group and the study group;comparison of the operation time,intraoperative blood loss,intraoperative warm saline flushing volume of the abdominal cavity（35°C）,and total fluid volume during operation.Statistically significant comparable（P>0.05）.2.The recovery time of bowel sounds in the laparoscopic control group,low-grade group,and high-grade group were（15.4±2.3,14.7±1.7,13.3±1.9）h,the first exhaust time was（19.6±2.6,18.7±2.0,16.3±2.1）h,defecation time was（22.8±2.7,22.1±1.8,19.2±2.2）h,the white blood cell counts on the first day were（8.65±3.04,8.02±2.15,6.85±1.69）×10⁹/L,the percentages of neutrophils was（74.79±10.71,74.25±9.39,69.47±9.33）%,potassium was（3.58±0.33,3.59±0.30,3.81±0.46）mmol/L,D-dimer was（0.84±1.14,0.77±0.90,0.35±0.21）mg/L,and fibrinogen content was（3.59±1.06,3.98±1.72,3.09±0.62）g/L,the differences were statistically significant（F=13.002,25.209,29.960,6.319,3.726,5.018,3.918,5.452,all P<0.05）.Pairwise comparison between the groups,LSD post-test found that there was statistical significance between the high-grade group and the control group and the low-grade group（P<0.05）,but the difference between the low-grade group and the control group was not statistically significant（P>0.05）.3.The recovery time of bowel sounds in the open control group,the low-grade group,and the high-grade group were（19.9±1.9,19.2±1.4,18.1±1.5）h,the first exhaust time was（23.5±2.2,22.7±1.9,21.3±1.9）h,and the defecation time was（25.6±3.1,25.1±1.9,23.1±1.8）h,the white blood cell counts on the first day was（10.99±3.15,10.23±2.67,8.39±1.76）×10⁹/L,the percentage of neutrophils was（82.32±5.90,82.25±5.83,75.10±7.76）%,potassium was（3.69±0.42,3.69±0.50,4.11±0.45）mmol/L,D-dimer was（0.60±0.48,0.52±0.68,0.19±0.15）mg/L,and fibrinogen content is（3.92±1.66,3.61±1.21,2.67±0.61）g/L,the difference was statistically significant（F=10.382,10.710,9.122,6.150,10.041,9.287,5.129,5.655,all P<0.05）.Pairwise comparison between the groups,LSD post-test found that the difference between the high-grade group and the control group and the low-grade group was statistically significant（P<0.05）,but the difference between the low-grade group and the control group was not statistically significant（P>0.05）.4.In the laparoscopic control group,20 of the 60 patients had abdominal distension,with an incidence of 33.3%;17patients with DVT had an incidence of 28.3%.In the low-grade group,10 of34 patients had abdominal distension,with an incidence of 29.4%;9 patients with DVT had an incidence of 26.5%.In the high-grade group,2 out of 40 had abdominal distension,with an incidence rate of 5%;1 had DVT with an incidence rate of 2.5%,the difference was statistically significant（c²=11.366,11.086,both P<0.05）.Pairwise comparison between the groups showed that the difference between the high-grade group and the control group was statistically significant(c²_腹胀=11.228,P=0.001;c²_DVT=10.851,P=0.001);the difference between the high-grade group and the low-grade group was statistically significant(c²_腹胀=8.061,P=0.005;Fisher’s exact test in DVT P=0.004);there was no statistically significant difference between the low-grade group and the control group（P>0.05）.5.Twenty-three out of 50patients in the open control group developed abdominal distension,an incidence rate of 46%;19 patients had DVT,an incidence rate of 38%.In the low-grade group,9 out of 20 had abdominal distension,with an incidence of45%;7 had DVT with an incidence of 35%.In the high-grade group,2 out of30 had abdominal distension,with an incidence of 6.7%;1 had DVT with an incidence of 3.3%,the difference was statistically significant（c²=14.275,12.244,both P<0.05）.Pairwise comparison between the groups showed that the difference between the high-grade group and the control group was statistically significant(c²_腹胀=13.502,P=0.000;c²_DVT=12.018,P=0.001);the difference between the high-end group and the low-grade group was statistically significant（Fisher’s exact test in abdominal distension P=0.004;Fisher’s exact test in DVT P=0.005）;compared with the control group,the difference was not statistically significant（P>0.05）.Conclusions:1.Laparoscopic and open total hysterectomy can shorten the recovery time of bowel sounds,the time of first exhaust,and the time of defecation.It can reduce the white blood cell count,the percentage of neutrophils,the increased content of D-dimer and fibrinogen and keep blood potassium low can reduce the incidence of abdominal distension and the incidence of DVT.2.The suitable temperature for keeping the feet warm during laparoscopic and open total hysterectomy is the high-grade warming temperature of 40℃,and the low-grade warming effect is not significant.