肩关节镜术中低体温情况的观察性研究

Perioperative hypothermia during shoulder arthroscopy surgery:An observational study

目的观察肩关节镜术中围手术期低体温的发生率以及影响因素。方法回顾性分析2020年6月至2020年9月以及2020年12月至2021年2月于本院治疗的161例肩关节镜手术患者,排除1例年龄过小、2例合并颈椎病、3例数据不全的患者,实际入组参与研究患者155例,其中左侧肩66例、右侧肩89例;男50例、女105例(男:女=1:2);平均年龄(58.87±11.50)岁(19~79岁)。126例肩袖损伤,9例肩关节不稳定,1例肱骨大结节骨折,16例冻结肩,3例钙化性肌腱炎。记录患者的基本资料、手术时长、麻醉分级、麻醉方式、术中体温保护措施、手术室的温度,对这些数据进行统计学的分析,评估围手术期低体温的发生率以及危险因素。结果针对155例肩关节镜患者的资料分析结果可见手术开始时有43例患者的体温均处于低体温状态,112例患者处于正常范畴,低体温发生率为27.74%。而在手术结束时出现低体温状态的患者有62例,而93例患者处于正常范畴,术后的低体温发生率为40%。所有的低体温状态均处于轻度的围手术期低体温范畴。麻醉后出现低体温的患者中,性别和BMI的比值差异具有统计学意义,而术中及结束时出现低温的情况则与年龄、性别、手术时间、灌注量和保温措施相关。并且当手术时间超过90 min后,灌注液对核心体温的影响起到了主导作用。结论肩关节镜手术中多种因素与围手术期低体温相关,常温灌注液体也对核心体温起到一定的影响作用,导致围手术期低体温的发生。

Background There was much attention focused on the perioperative physiological states,and during the state,the hypothermia could significantly affect postoperative clinical outcomes.With the development of shoulder arthroscopy,the related perioperative physiological conditions are also continuously recognized.Still,few reports are on the influencing factors and clinical functions of perioperative hypothermia during shoulder arthroscopy.Objective Investigation of the perioperative hypothermia and factors that influence hypothermia in shoulder arthroscopy.Methods A total of 161 patients with shoulder arthroscopy treatment were retrospectively analyzed.The patient’s general information,operative time,ASA,anesthesia method,heat preservation measure and operating room temperature,etc.,were recorded.These data and the incidence of hypothermia during the perioperative period and the risk factors were statistically analyzed.Results According to the data analysis results of 155 cases of shoulder arthroscopy,the incidence of hypothermia was 27.74%after general anesthesia,and the incidence of hypothermia postoperatively was 40%.The hypothermia showed a significant correlation with gender and BMI after anesthesia.The occurrence of hypothermia during and at the end of the operation is closely related to age,gender,operation time,irrigation fluid volume,and heat preservation measure.When the operation time exceeds 90 minutes,the irrigation fluid temperature has an essential role in changing the core temperature.Conclusion Various factors in shoulder arthroscopy are associated with perioperative hypothermia.The temperature of the irrigation fluid also has a particular effect on the core temperature,leading to the occurrence of hypothermia during the perioperative period.