新生儿非心脏手术术中低体温对预后的影响

Association between intraoperative hypothermia and outcomes in neonatal patients undergoing non-cardiac surgery

目的探讨新生儿非心脏手术术中低体温对预后的影响。方法回顾性收集2020年1月至2022年10月浙江大学医学院附属儿童医院1008例新生儿非心脏手术资料。包括男558例,女450例,年龄[M(Q_(1),Q_(3))]为6(2,14)d。根据术中是否发生低体温(低于36℃)以及最低体温分为4组:正常体温组(n=246)、轻度低体温组(最低体温35.0~35.9℃,n=434)、中度低体温组(最低体温34.0~34.9℃,n=232)和重度低体温组(最低体温<34℃,n=96)。主要观察指标为术中低体温发生率,比较4组患儿术后住院时间、术后30 d死亡率、术后肺部并发症发生率、术后出血/输血率以及酸中毒发生率等预后指标的差异。采用二元logistic回归分析低体温对患儿术后住院时间延长(>14 d)、术后30 d死亡率和术后并发症等的影响。结果1008例患儿中,762例(75.6%)发生了术中低体温,其中轻度、中度、重度低体温发生率分别为43.1%(434/1008)、23.0%(232/1008)和9.5%(96/1008)。体温正常组、轻度低体温组、中度低体温组和重度低体温组新生儿术后住院时间分别为9.0(5.8,18.0)、12.0(7.0,21.0)、17.0(10.0,34.5)和31.5(12.5,55.8)d,术后30 d死亡率分别为2.9%(7/246)、4.4%(19/434)、6.9%(16/232)和14.7%(14/96),术后肺部并发症发生率分别为31.7%(78/246)、39.9%(173/434)、44.8%(104/232)和67.4%(64/96),术后出血/输血率分别为19.9%(49/246)、32.3%(140/434)、49.1%(114/232)和79.0%(75/96),酸中毒发生率分别为26.8%(66/246)、35.7%(155/434)、44.4%(103/232)和46.3%(44/96),差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,相对于正常体温,重度低体温与术后住院时间延长(OR=1.962,95%CI:1.063~3.619)和发生术后肺部并发症(OR=2.020,95%CI:1.149~3.553)有关联;轻度、中度、重度低体温可增加术后出血/输血风险(轻度:OR=1.690,95%CI:1.080~2.644;中度:OR=2.382,95%CI:1.444~3.927;重度:OR=8.334,95%CI:3.123~8.929);轻度、中度低体温可增加术后酸中毒风险(轻度:OR=1.458,95%CI:1.009~2.107;中度:OR=1.949,95%CI:1.279~2.972)。结论术中低体温会延长非心脏手术新生儿术后住院时间,增加术后30 d死亡、肺部并发症、出血/输血和酸中毒的风险。

Objective To investigate the impact of intraoperative hypothermia on postoperative outcome in neonatal patients undergoing non-cardiac surgery.Methods The data of 1008 neonates undergoing non-cardiac surgery in Children′s Hospital,Zhejiang University School of Medicine from January 2020 to October 2022 were retrospectively collected,which included 558 males and 450 females,with a midian age[M(Q_(1),Q_(3))]of 6(2,14)days.Neonates were divided into 4 groups according to whether hypothermia(below 36℃)occurred and the lowest body temperature during the surgery:normal temperature group(n=246),mild hypothermia group(the lowest temperature ranged 35.0-35.9℃,n=434),moderate hypothermia group(the lowest temperature ranged 34.0-34.9℃,n=232)and severe hypothermia group(the lowest temperature<34℃,n=96).The primary outcome was the incidence of intraoperative hypothermia.The four groups′difference of postoperative hospital stay,postoperative mortality within 30 days,postoperative pulmonary complications,postoperative hemorrhage/blood transfusion and acidosis were compared.Multivariate logistic regression was used to analyze the relationship between intraoperative hypothermia and prolonged postoperative hospital stay(>14 d),30 d-mortality and other complications.Results In the 1008 neonatal patients,762(75.6%)cases suffered intraoperative hypothermia,among which the incidence of mild,moderate and severe hypothermia was 43.1%(434/1008),23.0%(232/1008)and 9.5%(96/1008),respectively.The postoperative hospital stay in normal,mild,moderate and severe hypothermia groups was 9.0(5.8,18.0),12.0(7.0,21.0),17.0(10.0,34.5)and 31.5(12.5,55.8)days.The mortality rate with 30 days after surgery was 2.9%(7/246),4.4%(19/434),6.9%(16/232)and 14.7%(14/96),the incidence of postoperative pulmonary complications was 31.7%(78/246),39.9%(173/434),44.8%(104/232)and 67.4%(64/96),the rate of postoperative hemorrhage/blood transfusion was 19.9%(49/246),32.3%(140/434),49.1%(114/232)and 79.0%(75/96),and the incidence of acidosis was 26.8%(66/246),35.7%(155/434),44.4%(103/232)and 46.3%(44/96),respectively.All differences were statistically significant(all P<0.05).According to the adjusted logistic regression analysis,compared with the normal body temperature group,severe hypothermia was associated with prolonged postoperative hospital stay(OR=1.962,95%CI:1.063-3.619)and postoperative pulmonary complications(OR=2.020,95%CI:1.149-3.553).The mild,moderate and severe hypothermia group could increase the risk of postoperative blood/transfusion rate(mild:OR=1.690,95%CI:1.080-2.644;Moderate:OR=2.382,95%CI:1.444-3.927;Severe:OR=8.334,95%CI:3.123-8.929).The mild and moderate hypothermia could raise the risk of acidosis(mild:OR=1.458,95%CI:1.009-2.107;Moderate:OR=1.949,95%CI:1.279-2.972).Conclusion Intraoperative hypothermia can prolong the postoperative hospital stay,and increase the risk of postoperative mortality,postoperative pulmonary complications,postoperative hemorrhage/transfusion,and acidosis.