老年患者全身麻醉腹腔镜下子宫切除术中低体温发生情况及危险因素

Incidence and Risk Factors of Hypothermia in Elderly Patients Undergoing Laparoscopic Hysterectomy under General Anesthesia

目的:探讨老年患者全身麻醉腹腔镜下子宫切除术中低体温发生情况及危险因素。方法:回顾性选取2021年7月—2023年7月于广州市番禺区市桥医院进行全身麻醉腹腔镜下子宫切除术的老年患者200例,通过单因素及多因素分析的应用明确患者发生低体温的情况及相关危险因素。200例患者,发生低体温的纳入A组,未发生的纳入B组。结果:A组和B组美国麻醉医师协会(American stroke association,ASA)分级Ⅲ级对比,差异无统计学意义(P>0.05);两组的术中静脉输液量>1000 mL、年龄≥70岁、术中腹腔冲洗液量>1500 mL、术前存在焦虑情况、术中二氧化碳气腹时间>120 min、术中出血量>150 mL、术中二氧化碳加温到37℃、体重指数(body mass index,BMI)<24 kg/m^(2)、术中二氧化碳灌注量>200 L、术前存在轻中度贫血占比情况比较,差异均有统计学意义(P<0.05)。多因素结果显示,术中二氧化碳加温到37℃为保护性因素;而术前存在中轻度贫血情况、术中腹腔冲洗液量>1500 mL、年龄≥70岁、术中二氧化碳气腹时间>120 min、术中二氧化碳灌注量>200 L、术中静脉输液量>1000 mL、术前存在焦虑情况、BMI<24 kg/m^(2)、术中出血量>150 mL是导致全身麻醉腹腔镜下子宫切除术老年患者发生低体温的危险因素。结论:老年全身麻醉腹腔镜下子宫切除术患者低体温的发生率较高,而发生原因与术中二氧化碳加温、患者年龄、腹腔冲洗液量、术前有无贫血、气腹时间及二氧化碳灌注情况等存在密切关系,因此实际中需要以此进行指定性措施的制订,以此降低低体温的发生率。

Objective:To explore the incidence and risk factors of hypothermia in elderly patients undergoing laparoscopic hysterectomy under general anesthesia.Method:A total of 200 elderly patients who underwent laparoscopic hysterectomy under general anesthesia at Shiqiao Hospital,Panyu District,Guangzhou City from July 2021 to July 2023 were retrospectively selected.The incidence of hypothermia and related risk factors were identified through the application of univariate and multivariate analysis.Among the 200 selected patients,those who experienced hypothermia were included in group A,while those who did not were included in group B.Result:There was no statistically significant difference between group A and group B in terms of American stroke association(ASA)gradeⅢclassification(P>0.05);the proportion of patients with intraoperative intravenous infusion volume>1000 mL,the age≥70 years,the intraoperative abdominal flushing fluid volume>1500 mL,anxiety before surgery,the intraoperative carbon dioxide pneumoperitoneum time>120 min,the intraoperative bleeding volume>150 mL,the intraoperative carbon dioxide heated to 37℃,and the body mass index(BMI)<24 kg/m^(2),the intraoperative carbon dioxide infusion volume>200 L and mild to moderate anemia before surgery were compared between the two groups,the differences were statistically significant(P<0.05).The results of multiple factors showed that intraoperative warming carbon dioxide to 37℃was protective factor;the risk factors for hypothermia in elderly patients undergoing laparoscopic hysterectomy under general anesthesia included mild to moderate anemia before surgery,abdominal lavage fluid volume>1500 mL during surgery,age≥70 years,carbon dioxide pneumoperitoneum time>120 min during surgery,carbon dioxide perfusion volume>200 L during surgery,intravenous infusion volume>1000 mL during surgery,preoperative anxiety,BMI<24 kg/m^(2),and intraoperative bleeding volume>150 mL.Conclusion:The incidence of hypothermia in elderly patients undergoing laparoscopic hysterectomy under general anesthesia is relatively high,and the causes of hypothermia are closely related to intraoperative carbon dioxide warming,age of patient,abdominal flushing fluid volume,preoperative anemia,pneumoperitoneum time,and carbon dioxide perfusion.Therefore,in practice,specific measures need to be formulated to reduce the incidence of hypothermia.