主动脉手术后非感染性发热的临床研究

Clinical Research on Noninfectious Fever Following Aortic Surgery

目的研究主动脉手术后非感染性发热的发生率、临床过程、危险因素及其对患者转归的影响。方法回顾性研究2006年1月至2008年1月期间因主动脉瘤或主动脉夹层在北京阜外心血管病医院行手术治疗549例患者的临床资料,在排除术前或术后明确合并感染者、术前发热者(口腔温度≥38℃)、急诊手术者、非发热相关原因死亡者及病历资料不全者后,将最终入选的463例患者按照术后是否发热分为发热组(345例,非感染性发热,最高口温38.0～39.3℃)和无发热组(118例,术后无发热);对两组患者的一般资料、手术资料和术后情况等进行组间比较;对P≤0.001的指标行多元logistic回归分析,以寻找影响术后非感染性发热的预测指标。结果主动脉手术后有74.5%(345/463)的患者出现非感染性发热。手术结束当天和术后第1 d发热组患者最低日体温高于无发热组(P=0.000,0.000);手术结束当天、术后第1 d、2 d、3 d和4 d,发热组患者的最高日体温均高于无发热组(P=0.000,0.000,0.000,0.047,0.018)。单变量分析结果:体重(P=0.000)、手术类型(P=0.000)、术中膀胱温度最低值(P=0.000)、ICU口温(P=0.000)和输血(P=0.000)均为影响术后发热的危险因子;多元logistic回归分析结果:胸主动脉和胸腹主动脉手术(比值比:4.861;95%的可信区间:3.029,5.801;P=0.004),较低的术中膀胱温度最低值(比值比:1.117;95%的可信区间:1.013,1.244;P=0.040)和较高的ICU初始口温(比值比:2.570;95%的可信区间:1.280,5.182;P=0.008)均是术后非感染性发热的预测因子。结论主动脉手术后非感染性发热十分常见,手术部位(胸主动脉或胸腹主动脉)、术中低核心体温及术后短期内体温升高可能是主动脉手术后非感染性发热的危险因素。

Objective To determine the incidence,course,potential risk factors and outcomes of postoperative noninfectious fever in aortic surgical patients.Methods We reviewed 549 patients who received operation for aortic aneurysm or dissection in Beijing FuWai Cardiovascular Disease Hospital from January 2006 to January 2008.After excluding patients with a known source of infection during hospitalization,patients who had preoperative oral temperature greater than or equal to 38.0℃,patients who underwent emergency surgery,patients who died of other reasons other than fever-related factors,and patients with incomplete data,we finally enrolled a total of 463 patients for final analysis.Depending on whether the patients developed a noninfectious fever after operation,we classified them into the febrile group（n=345,highest oral temperature ranging from 38.0-39.3℃） and the afebrile group（n=118,without postoperative fever）.Univariate analysis was performed between these two groups of patients,with respect to demographics,operative data and postoperative conditions.Risk factors for postoperative fever were considered for the multivariate logistic regression model if they had aPvalue≤0.001 in the univariate analysis.Results After operation,74.5%（345/463） of the patients had noninfectious fever.The minimum temperature of febrile patients on the operation day and the first postoperative day were both higher than afebrile patients（P= 0.000,0.000）.The maximum temperature of febrile patients on the operation day,the first,second,third and fourth postoperative days were also higher than afebrile patients（P= 0.000,0.000,0.047,0.018）.Univariate analysis demonstrated that weight（P= 0.000）,surgical type（P= 0.000）,minimum intraoperative bladder temperature（P= 0.000）,temperature upon ICU admission（P=0.000） and blood transfusion（P=0.000） were all risk factors for noninfectious