椎管内麻醉并发寒战反应的相关因素分析

Analysis of the risk factors of shivering after intraspinal anesthesia

目的：探讨椎管内麻醉后并发寒战反应相关影响因素。方法将2011年2月至2015年5月进行椎管内麻醉手术后进行麻醉恢复者640例作为研究对象，根据患者是否出现寒战反应将患者分为研究组和对照组，研究组包括出现寒战者，共328例，对照组包括未出现寒战者，共312例。对患者进行基本临床资料、手术时间和出血量、鼓膜温度、麻醉方式、麻醉阻滞平面等指标对比，探讨椎管内麻醉并发寒战反应的危险因素。结果640例患者中328例出现寒战反应，发生率为51．25％。单因素结果显示年龄较轻、男性、中心温度较低、手术时间持续较长、手术出血量较多、麻醉阻滞方式选择腰麻及麻醉阻滞平面在T8以上等指标与椎管内麻醉并发寒战反应存在密切关系，组间数据差异均有统计学意义（χ2＝40．661、17．208、32．369、32．931、36．624、14．844、26．842，均P＜0．05）。多因素logistic回归分析结果显示，年龄、性别、中心体温、手术时间、出血量、椎管内麻醉方式及麻醉阻滞平面等指标是椎管内麻醉患者麻醉后出现寒战反应的重要危险因素（OR＝1．843、1．925、2．183、0．548、0．497、0．529、0．743，均P＜0．05）。结论男性、年龄较轻、手术时间持续较长、术中出血量较大、鼓膜温度较低、麻醉方式选择蛛网膜下腔阻滞以及麻醉平面较高等因素是椎管内麻醉患者出现寒战反应的主要危险因素，在围手术期内需要对具有上述因素的患者进行密切监测。

Objective To explore the risk factors of shivering after intraspinal anesthesia.Methods 640 anesthesia recovery patients after intraspinal anesthesia from February 2011 to May 2015 were selected as the research subjects.According to whether patients appeared shivering,they were divided into research group and control group.The research group had 328 cases of appearing shivering,the control group had 312 cases without shivering. Basic clinical data of patients,operation time and blood loss,tympanic membrane temperature,anesthesia,anesthesia blocks plane indicators were compared to explore the risk factors of shivering after intraspinal anesthesia.Results This study included 640 cases,including 328 cases with chills reaction,the incidence rate was 51.25%.Single factor results showed that the low age,male,central cooler,surgery for a long time,the bleeding of more lumbar hemp,choice＆amp;nbsp;of anesthetic methods and anesthetic plane above T8 indicators, there were close relationship with shivering after intraspinal anesthesia,the differences between the two groups were statistically significant （χ2 =40.661,17.208, 32.369,32.931,36.624,14.844,26.84,all P〈0.05）.Multivariable logistic regression analysis results showed that age,gender,core body temperature,operation time,blood loss,spinal canal anesthesia methods and indexes of anes-thetic plane were important risk factors of chills reaction after anesthesia in patients with spinal canal anesthesia （OR=1.843,1.925,2.183,0.548,0.497,0.529,0.743,all P〈0.05）.Conclusion Male,younger age,operation for a long time,big intraoperative blood loss,tympanic membrane temperature low mode selection subarachnoid block anesthesia,and the anesthesia plane factor are the main risk factors of spinal canal anesthesia patients to appear chills response,the above factors are needed for close monitoring of patients with intraspinal anesthesia in the preoperative period.