老年病人行D2胃癌根治术中体温水平对病人短期预后的影响

Effect of intraoperative temperature on the short-term prognosis of elderly patients undergoing D2 radical resection of gastric cancer

[目的]探讨老年病人行D2胃癌根治术中体温水平对病人短期预后的影响。[方法]回顾性分析2015年6月—2018年10月于西南医科大学附属医院行D2胃癌根治术的118例老年病人的临床资料,分别于手术开始时(T1)、吻合后(T2)、手术结束(T3)测量体温,获得术中体温水平。通过ROC曲线分析术中体温水平与术后预后的相关性,并获得最佳截断点(Ta);根据Ta将病人分为T组(T≥Ta)与t组(T<Ta),比较两组病人的术后短期预后情况,并采用Logistic回归法对术后短期预后情况的影响因素进行分析。[结果]通过ROC曲线计算得出,Ta=36.35℃。T组的体温水平[(36.68±0.18)℃]明显高于t组[(36.17±0.10)℃],t组病人术中冲洗率(69%)高于T组(47%),T组并发症发生率明显低于t组,差异均有统计学意义(P<0.05)。ASA分级[OR=2.235,95%CI(1.280,7.630),P=0.048]、术中体温水平[OR=8.363,95%CI(2.235,10.125),P=0.023]以及分组[OR=8.462,95%CI(3.563,14.462),P=0.016]为术后短期预后的危险因素。[结论]老年病人行D2胃癌根治术中体温水平是病人短期预后的影响因素,术中体温低于36.35℃提示术后短期预后差,易发生并发症。

Objective:To investigate the effect of body temperature on short-term prognosis in elderly patients undergoing D2 radical resection of gastric cancer.Methods:The clinical data of 118 elderly patients who underwent D2 radical gastrectomy in the Affiliated Hospital of Southwest Medical University from June 2015 to October 2018 were retrospectively analyzed.The body temperature was measured at the beginning of operation(T1),after anastomosis(T2),and at the end of operation(T3).The correlation between intraoperative body temperature and postoperative prognosis was analyzed by ROC curve,and the optimal cut-off point(Ta)was obtained.According to Ta,the patients were divided into t group(t≥Ta)and T group(T<Ta).The short-term prognosis of the two groups was compared,and the influencing factors of short-term prognosis were analyzed by logistic regression method.Results:By ROC curve calculation,the value of Ta was36.35℃.The body temperature of T group was significantly higher than that of t group[(36.68±0.18)℃vs(36.17±0.10)℃],the irrigation rate in t group was higher than that in T group(69%vs 47%).The incidence of complications in T group was significantly lower than that in t group,the differences were all statistically significant(P<0.05).ASA grade[OR=2.235,95%CI(1.280,7.630),P=0.048],intraoperative body temperature[OR=8.363,95%CI(2.235,10.125),P=0.023]and grouping[OR=8.462,95%CI(3.563,14.462),P=0.016]were risk factors for short-term prognosis.Conclusions:The body temperature level was the influencing factor of short-term prognosis in elderly patients undergoing D2 radical gastrectomy.The intraoperative body temperature lower than 36.35℃indicated that the short-term prognosis was poor and complications were easy to occur.