蛛网膜下腔麻醉后低体温的发生情况及危险因素

Development of hypothermia after spinal anesthesia and risk factors

目的评价蛛网膜下腔麻醉后低体温的发生情况及危险因素。方法纳入2020年4月至2021年4月于本院麻醉准备室行蛛网膜下腔麻醉的患者。于蛛网膜下腔麻醉前、麻醉后即刻、麻醉后5、10、15 min时测量鼓膜温度,任意时点鼓膜温度<36℃为发生低体温,纳入低体温组,体温≥36℃的患者纳入非低体温组。记录患者一般情况、最高麻醉平面、穿刺间隙、麻醉用药种类、术前禁食水时间及手术部位。采用logistic回归分析筛选低体温的危险因素。结果共纳入患者196例。与麻醉前和麻醉后即刻比较,麻醉后5、10 min时体温降低(P<0.001),低体温发生率10.2%。logistic回归分析结果显示,女性、较高的麻醉平面是低体温发生的独立危险因素,较高的基础体温是其独立保护因素(P<0.05)。结论蛛网膜下腔麻醉后5~10 min体温已降低,低体温的发生并非小概率事件;女性、较高的麻醉平面是其危险因素,而较高的基础体温是其保护因素。

Objective To evaluate the development of hypothermia after spinal anesthesia and risk factors.Methods Patients undergoing spinal anesthesia in the anesthesia preparation room of our hospital from April 2020 to April 2021 were included.The temperature of the tympanic membrane was measured before spinal anesthesia and immediately after anesthesia and at 5,10 and 15 min after anesthesia.Patients with tympanic membrane temperature<36℃at any time point were considered as having hypothermia and included in hypothermia group and patients with membrane temperature≥36℃were considered as having no hypothermia and included in non-hypothermia group.The patients′demographic data,highest anesthesia plane,puncture space of spinal anesthesia,types of anesthetics,preoperative fasting time,and surgical sites were recorded.The multivariate logistic regression analysis was performed to identify the risk factors for hypothermia.Results A total of 196 patients were finally enrolled.The body temperature was significantly decreased at 5 and 10 min after anesthesia compared with the baseline body temperature before anesthesia and immediately after anesthesia(P<0.001),and the incidence of hypothermia was 10.2%.The multivariate logistic regression analysis showed that female and high anesthesia plane were independent risk factors for hypothermia,and higher baseline body temperature was an independent protective factor for hypothermia(P<0.05).Conclusions Body temperature decreases at 5-10 min after spinal anesthesia,and the occurrence of hypothermia is not a small probability event in the patients undergoing spinal anesthesia;female and higher anesthesia plane are risk factors and higher baseline body temperature is the protective factor.