胸腔镜术后患者麻醉复苏室低体温发生的围术期影响因素分析

Perioperative influencing factors of hypothermia for the patients underwent thoracoscopic surgery in post-anesthesia care unit

目的分析胸腔镜手术患者麻醉复苏室发生低体温的临床特征,探讨其围术期影响因素,为临床制定干预措施提供依据。方法回顾性分析2020年6月至2022年6月在我院行胸腔镜手术治疗的182例患者的临床资料,根据麻醉复苏室低体温发生与否将其分为正常体温组和低体温组。采用单因素分析比较两组患者性别、年龄、BMI、ASA分级、入室体温、准备时间、麻醉方式与时间、术中输液量、原发疾病、术前血糖、白蛋白水平以及手术结束至麻醉复苏室时间,对有统计学差异的上述因素行logistic回归分析影响麻醉复苏室低体温发生的相关因素。结果182例胸腔镜手术患者中,麻醉复苏室发生低体温86例(低体温组),正常体温96例(正常体温组)。单因素分析显示,年龄、BMI、麻醉方式、麻醉时长、入室体温、准备时间、手术结束至麻醉复苏室时间是低体温发生的影响因素,低体温组与正常体温组间比较差异均有统计学意义(P<0.05),而两组性别、ASA分级、术中输液量、原发疾病、术前血糖及血清白蛋白水平比较均无统计学差异(P>0.05)。经logistic回归分析显示,年龄增加、复合麻醉、麻醉时长≥3 h、准备时间≥1 h、手术结束至苏醒时间延长为影响患者麻醉复苏室低体温发生的独立危险因素,而BMI>24 kg/m^(2)和入室体温≥36.5℃为保护因素。术后低体温组麻醉复苏室滞留时间、住院时间均明显长于正常体温组(P<0.05),尿量明显少于正常体温组(P<0.05)。结论胸腔镜手术患者麻醉复苏室低体温的发生率较高,对于年龄较大、采用复合麻醉、麻醉时长≥3 h、准备时间≥1 h、手术结束至苏醒时间延长的高危患者应予以重视,及时采取相应干预措施以降低麻醉复苏室低体温发生的风险。

Objective To investigate the clinical features of the patients with hypothermia in the postanesthesia care unit(PACU)after thoracoscopic surgery,analyze the perioperative influencing factors of hypothermia,and so as to provide evidence for clinical intervention.Methods The clinical data of 182 patients underwent thoracoscopic surgery in our hospital were retrospectively analyzed from June 2020 to June 2022.According to postoperative temperature in PACU,they were divided into the hypothermia group and the normothermia group.The gender,age,body mass index(BMI),ASA classification,admission temperature,operative preoparation time,anesthesia method and time,intraoperative infusion volume,primary disease,preoperative blood glucose,serum albumin level and the time from the end of surgery to PACU were compared by univariate analysis,then the variables mentioned above with statistical differences were incorporated into the multivariate logistic regression analysis to analyze the independent influencing factors of hypothermia in PACU after thoracoscopic surgery.Results Of the 182 postoperative patients in PACU,hypothermia occurred in 86 cases(as the hypothermia group,47.25%),and temperature was normal in 96 cases(as the normothermia group).The univariate analysis showed that age,BMI,anesthesia method,anesthesia duration,admission temperature,operative preoparation time and the time from end of surgery to PACU were the influencing factors of hypothermia in PACU,with significant differences between the two groups(P<0.05);Logistic regression analysis revealed that increasing of age,combined anesthesia,anesthesia duration(≥3 h),preparation time(≥1 h)and prolonged time from the end of surgery to PACU were the independent risk factors inducing hypothermia in PACU,while BMI(>24 kg/m^(2))and admission temperature(≥36.5℃)were the protective factors.Compared with normothermia group,the PACU stays and hospital stays were longer,and urine volume was less in the hypothermia group(P<0.05).Conclusions The incidence of hypothermia was relatively high in the patients underwent thoracoscopic surgery in PACU.For the patients with high-risk factors such as older age,combined anesthesia,anesthesia duration(≥3 h),preparation time(≥1 h)and prolonged recovery time from the end of surgery to PACU would be paid more attention and corresponded appropriate intervention measures to reduce the incidence of hypothermia in PACU.