全身麻醉患者苏醒室内低体温发生情况及危险因素研究
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摘要
目的评估全身麻醉术后患者苏醒室内低体温的发生率,分析相关危险因素并初步建立预警评分系统。方法选取自2017年7—9月于海军军医大学附属长海医院接受全身麻醉手术并于术毕入苏醒室的2 001例患者为研究对象。患者进入苏醒室后即刻采用红外耳温枪测量右侧鼓膜温度作为体温记录。根据患者进入苏醒室内即刻记录的体温值,将体温<36.0℃者计入低体温组,体温≥36.0℃计入正常体温组。比较不同性别、年龄、体质量指数、手术时间、美国麻醉医师协会(ASA)分级、失血量、输液量及输血量的患者的低体温发生率。根据各危险因素比值比,构建全身麻醉术后苏醒室内低体温的预警评分系统。结果全身麻醉术后患者苏醒室内低体温患者256例,低体温发生率为12.8%(256/2 001)。二分类Logistic回归多因素分析显示,年龄、体质量指数、输液量、输血情况、ASA分级均是低体温发生的独立危险因素。根据各独立危险因素的β值所得评分建立全身麻醉术后苏醒室内低体温的风险评估与验证模型,绘制得出受试者工作特征曲线的曲线下面积值为0.691(95%可信区间0.657～0.725,P<0.05)。结论年龄、体质量指数、输液量、输血情况、ASA分级均是低体温发生的独立危险因素。本研究构建的预警评分系统,对预测全身麻醉术后苏醒室内低体温的准确性较高。
Objective To evaluate the incidence of hypothermia in surgical patients after general anesthesia,to analyze the related risk factors and establish an early warning scoring system.Methods A retrospective study was performed on 2 001 cases of patients who underwent general anesthesia from July to September 2017.The right tympanic membrane temperature was measured with a red ear thermometer as a temperature record immediately after the patient entered the resuscitation room.According to indoor awakening patients′immediate record temperature value,the temperature less than 36.0℃ were divided into the hypothermia group,and the temperature was 36.0℃ or higher were in the normal temperature group.To compare the incidence of hypothermia among patients of different gender,age,body mass index,operative time,American association of anesthesiologists(ASA)classification,blood loss,infusion volume and blood transfusion.According to the ratio of risk factors,the early-warning scoring system of indoor hypothermia was established.Results There were 256 cases of patients with hypothermia,and the incidence of hypothermia was 12.8%(256/2 001).Binary Logistic regression multivariate analysis showed that age,body mass index,infusion volume,blood transfusion and ASA classification were all independent risk factors for hypothermia.A risk assessment and validation model for indoor hypothermia after anaesthesia was established based on the score of each independent risk factor,and the area under the curve of the subject′s working characteristic curve was drawn to be 0.691(95% CI:0.657-0.725,P<0.05).Conclusion Age,body mass index,infusion volume,blood transfusion volume and ASA classification are all independent risk factors for hypothermia.The early-warning scoring system constructed in this study has a high accuracy in predicting the indoor hypothermia after awakening after general anesthesia.
Objective To evaluate the incidence of hypothermia in surgical patients after general anesthesia,to analyze the related risk factors and establish an early warning scoring system.Methods A retrospective study was performed on 2 001 cases of patients who underwent general anesthesia from July to September 2017.The right tympanic membrane temperature was measured with a red ear thermometer as a temperature record immediately after the patient entered the resuscitation room.According to indoor awakening patients′immediate record temperature value,the temperature less than 36.0℃ were divided into the hypothermia group,and the temperature was 36.0℃ or higher were in the normal temperature group.To compare the incidence of hypothermia among patients of different gender,age,body mass index,operative time,American association of anesthesiologists(ASA)classification,blood loss,infusion volume and blood transfusion.According to the ratio of risk factors,the early-warning scoring system of indoor hypothermia was established.Results There were 256 cases of patients with hypothermia,and the incidence of hypothermia was 12.8%(256/2 001).Binary Logistic regression multivariate analysis showed that age,body mass index,infusion volume,blood transfusion and ASA classification were all independent risk factors for hypothermia.A risk assessment and validation model for indoor hypothermia after anaesthesia was established based on the score of each independent risk factor,and the area under the curve of the subject′s working characteristic curve was drawn to be 0.691(95% CI:0.657-0.725,P<0.05).Conclusion Age,body mass index,infusion volume,blood transfusion volume and ASA classification are all independent risk factors for hypothermia.The early-warning scoring system constructed in this study has a high accuracy in predicting the indoor hypothermia after awakening after general anesthesia.
引文
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[2] Horosz B,Malec-Milewska M.Inadvertent intraoperative hypothermia.anaesthesiol intensive Ther[J].2013,45(1):38-43.
[3] Putzu M,Casati A,Berti M,et al.Clinical complications,monitoring and management of perioperative mild hypothermia:anesthesiological features[J].Acta Biomed,2007,78(3):163-169.
[4] Vaughan MS,Vaughan RW,Cork RC.Postoperative hypothermia in adults:relationship of age,anesthesia,and shivering to rewarming[J].Anesth Analg,1981,60(10):746-751.
[5] Yi J,Lei Y,Xu S,et al.Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia:national study in China[J].PLoS One,2017,12(6):e0177221.
[6] Le Gall JR,Lemeshow S,Saulnier F.A new simplified acute physiology score(saps ii)based on a European/North American multicenter study[J].JAMA,1993,270(24):2957-2963.
[7] Yi J,Xiang Z,Deng X,et al.Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Beijing:a prospective regional survey[J].PLoS One,2015,10(9):e0136136.
[8] Giuliano KK,Hendricks J.Inadvertent perioperative hypothermia:current nursing knowledge[J].AORN J,2017,105(5):453-463.
[9] Fernandes LA,Braz LG,Koga FA,et al.Comparison of peri-operative core temperature in obese and non-obese patients[J].Anaesthesia,2012,67(12):1364-1369.
[10] Kimberger O,Kurz A.Thermoregulatory management for mild therapeutic hypothermia[J].Best Pract Res Clin Anaesthesiol,2008,22(4):729-744.