心脏瓣膜置换术后低体温相关因素的前瞻性队列研究

A prospective cohort study:risk factors for cardiac valve replacement-related hypothermia

目的研究行心脏瓣膜置换术后患者发生低体温相关因素。方法选取2020年3月至2023年3月进行心脏瓣膜置换术治疗的心脏瓣膜患者352例,建立前瞻性队列。搜集患者临床基本资料,352例行心脏瓣膜置换术患者按照术后是否发生低体温将其分为常温组279例和低体温组73例,对比2组不同时间段体温变化情况、心率及收缩压情况。单因素分析及多因素Logistics回归分析探讨心脏瓣膜置换术后低体温发生的相关因素。结果低体温组进行手术1 h(T3)、术毕30 min(T4)时体温低于常温组(P<0.05);低体温组心率、收缩压水平情况均低于常温组(P<0.05)。单因素分析显示,年龄、手术时间、麻醉时间、输液量、输血量、ASA分级在行心脏瓣膜置换术后患者发生低体温中差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、手术时间≥3 h、麻醉时间≥3 h、输液量≥500 mL、输血量≥500 mL、ASA分级Ⅲ~Ⅳ级是影响心脏瓣膜置换术后发生低体温的主要危险因素(P<0.05)。结论年龄≥60岁、手术时间≥3 h、麻醉时间≥3 h、输液量≥500 mL、输血量≥500 mL、ASA分级Ⅲ~Ⅳ级是影响心脏瓣膜置换术后发生低体温的主要危险因素;通过对以上因素进行分析,能够针对性的对患者制定治疗方案及干预措施,降低术后低体温发生率,提高患者预后。

Objective To follow the risk factors for cardiac valve replacement(CVR)-related hypothermia.Methods This was a prospective cohort study involving 352 patients underwent CVR in our hospital from March 2020 to March 2023.Baseline data of the patients were collected,and the patients were divided into normal temperature group(n=279)and hypothermia group(n=73)according to the presence or absence of postoperative hypothermia.The changes in body temperature,and heart rate,systolic blood pressure were compared between the two groups during different time periods.Univariate analysis and multivariate Logistics regression analyses were used to explore the risk factors for CVR-related hypothermia.Results At 1h(T3)and 30min(T4)of surgery,the levels of body temperature,heart rate and systolic blood pressure in the hypothermia group were significantly lower than the normal temperature group(all P<0.05).Univariate analysis showed that age,operation time,anesthesia time,infusion volume,transfusion volume,and the American Society of Anesthesia(ASA)grade were statistically different in hypothermia in patients undergoing CVF(P<0.05).Multivariate logistic regression analysis showed that age≥60 years old,operation time≥3 h,anesthesia time≥3 h,infusion volume≥500 mL,blood transfusion volume≥500 mL,gradeⅢ~ⅣASA were the main risk factors for CVR-related hypothermia.Conclusion The age≥60 years old,operation time≥3 h,anesthesia time≥3 h,infusion volume≥500 mL,blood transfusion volume≥500 mL,gradeⅢ~ⅣASA were the main risk factors for CVR-related hypothermia.By analyzing the above factors,targeted treatment plans and intervention measures can be formulated to reduce the incidence of postoperative hypothermia and improve prognosis.