剖宫产术中产妇发生寒战的影响因素分析

Analysis of the influencing factors of shivering during cesarean section of puerperaes

目的:探究剖宫产产妇术中发生寒战发生影响因素。方法:回顾性收集2021年1月-2023年12月本院产科收治的剖宫产产妇360例,采用寒战分级(BSAS)将产妇分为寒战组与非寒战组,运用单因素和多因素logistic分析法分析术中寒战的响因素。结果:360例术中发生寒战87例(24.2%),寒战组与非寒战组年龄、分娩前体质指数(BMI)、禁食时间、经产妇、急诊入院、麻醉方法、入室至麻醉成功时间、手术时间、失血量、术中输液量、输入液体温度、使用加温毯、使用右美托咪啶/艾司氯胺酮、焦虑自评量表(SAS)、抑郁自评量表(SDS)、产科急症、胎儿窘迫/新生儿窒息等均有差异(P<0.05)。多因素logistic分析显示,年龄大、禁食时间长、急诊入院、椎管内麻醉、入室至麻醉成功时间长、手术时间长、失血量大、术中输液量大、输入液体温度低、SAS高、SDS高、产科急症、胎儿窘迫/新生儿窒息失血量多均为寒战发生危险因素,分娩前BMI、经产妇、使用加温毯、使用右美托咪啶/艾司氯胺酮为保护因素(均P<0.05)。结论:剖宫产产妇术中寒战发生率较高,影响因素也较多,应针对影响因素积极防治,以降低发生率,提高手术安全性。

Objective:To investigate the influencing factors of shivering during cesarean section of puerperaes.Methods:360 puerperaes who had undergone cesarean section admitted to the obstetrics department of the hospital from January 2021 to December 2023 were collected retrospectively.These puerperaes were divided into group A(puerperaes with shivering during cesarean section)and group B(puerperaes without shivering during cesarean section)according to the score of bedside shivering assessment scale(BSAS).The univariate analysis and multi-factor logistic analysis were used to analyze the risk factors of the shivering situation of the puerperaes during cesarean section.Results:There were 87(24.2%)puerperaes with intraoperative shivering occurred in the 360 puerperaes.There were significant differences in the age,the body mass index(BMI)before delivery,the fasting time,the rate of multipara,the rate of emergency admission,the anesthesia method,the time from entering the operative room to successful anesthesia,the operation time,the blood loss,the intraoperative infusion quantity,the infusion temperature,the rate of warming blanket used,the rate of dexmedetomidine/esketatine used,the scores of self-rating anxiety scale(SAS)and self-rating depression scale(SDS),and the rates of obstetric emergencies and fetal distress/neonatal asphyxia of the puerperaes between the two groups(P<0.05).Multivariate logistic analysis showed that the advanced age,the long fasting time,the emergency admission,the spinal anesthesia,the long time from entering the operative room to successful anesthesia,the long operation time,the more blood loss,the more intraoperative infusion volume,the low temperature of infusion fluid,the high scores of SAS and SDS,the obstetric emergency and the fetal distress/neonatal asphyxia of the puerperaes were all the risk factors of their shivering occurrence.The BMI value before delivery,the multiparas,the warming blanket used and dexmedetomidine/esmketamine used of the puerperaes were all the protective factors of their shivering occurrence(all P<0.05).Conclusion:The incidence of shivering of the puerperaes during cesarean section is higher,and the influencing factors of which are many.The active prevention and treatment targeting these influencing factors should be taken for reducing the incidence of their shivering and improve their operative safety.