儿童脊柱侧弯矫形术围手术期低体温的相关因素分析

Influencing factors for perioperative hypothermia in children undergoing scoliosis correction surgery

目的探讨脊柱侧弯矫形术患儿围手术期低体温的相关因素。方法以2019年1月至2020年1月于首都医科大学附属北京儿童医院接受手术治疗的脊柱畸形患儿为研究对象。根据围手术期是否发生低体温,分为低体温组(n=147)和正常体温组(n=53)。比较两组患儿临床特征,采用多因素Logistic回归分析患儿围手术期发生低体温的危险因素。结果共实施脊柱侧弯矫形术200例,其中147例(147/200,73.5%)发生低体温。低体温组中,男64例,女83例,年龄6(3,12)岁;正常体温组中,男30例,女23例,年龄6(3,11)岁。两组患儿年龄、性别、体重、身高、身体质量指数(body mass index,BMI)、脊柱侧弯类型、麻醉时间、手术时间以及手术节段数目比较,差异均无统计学意义(P>0.05);而两组患儿输注异体血、单位输液量、基线体温差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,单位输液量大(OR=1.070,95%CI:1.010~1.133)、手术节段多(OR=1.117,95%CI:1.018~1.227)是导致低体温的独立危险因素;高基线体温(OR=0.064,95%CI:0.021~0.199)是预防低体温发生的独立保护因素。结论脊柱侧弯矫形手术中,输注液体多、手术节段多的患儿低体温的发生风险更高,维持高的基线体温有助于减少低体温的发生。

Objective To explore the risk factors in children undergoing scoliosis correction surgery.Methods From January 2019 to January 2020,clinical data were reviewed for 200 children with scoliosis.According to whether hypothermia occurred intraoperatively,they were divided into two groups of hypothermia(n=147)and normal body temperature(n=53).Clinical characteristics of two groups were compared and the potential risk factors of hypothermia examined by multivariate Logistics regression model.Results Posterior spinal fusion was performed.Hypothermia was observed in 147 children(73.5%).The age of hypothermia group was 6(3,12)years with 64 boys and 83 girls;normal body temperature group was 6(3,11)years with 30 boys and 23 girls.No statistically significant inter-group difference existed in age,gender,weight,height,body mass index(BMI),type of scoliosis,anesthetic time,operative duration or count of fused vertebrae(all P>0.05).As compared with normal body temperature group,hypothermia group had more transfusion of blood,larger unit infusion volume and lower baseline body temperature(P<0.05).Multivariate Logistics regression analysis indicated that large unit of infusion volume(OR=1.061,95%CI:1.002-1.124)and count of fused vertebrae(OR=1.150,95%CI:1.038-1.274)were independent risk factors for hypothermia.Baseline body temperature(OR=0.066,95%CI:0.022-0.200)was an independent protective factor.Conclusion During scoliosis correction surgery,children with more fluids and more fused levels are at a higher risk of hypothermia.And maintaining a high baseline body temperature helps to minimize the occurrence of hypothermia.