Bernabei A F, Levison M A, Bender J S
Department of Surgery, Wayne State University, Detroit Receiving Hospital.
J Trauma. 1992 Dec;33(6):835-9. doi: 10.1097/00005373-199212000-00007.
To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < or = 35 degrees C) upon arrival in the OR. There was a significant correlation between admission blood pressure and lowest intraoperative temperature (r = 0.60; p < 0.001). Multiple regression analysis revealed that the patient's lowest temperature (p < 0.001) and Trauma Score (TS); p < 0.0015), but not Abdominal Injury Severity Score (AISS) (p = 0.25) correlated with OR blood loss. The 28 patients with high TS (15 or 16) and AISS > or = 9 had significantly less blood loss when the OR temperature was maintained above 35 degrees C versus 33 degrees-35 degrees C (540 +/- 580 mL vs. 1820 +/- 1160 mL; p < 0.003). This suggests that hypothermia may exacerbate OR blood loss independent of degree of physiologic or anatomic injury. Thus hypothermia is common in patients undergoing a laparotomy for trauma. Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.
为评估核心体温（T）与腹部损伤后手术室（OR）失血及死亡率的其他相关因素之间的关系，我们回顾了底特律接收医院1989年1年期间122例行剖腹探查术治疗创伤患者的记录。大多数损伤为穿透伤（86%），死亡率为8.2%。总体而言，122例患者中有57例（47%）在进入手术室时体温过低（T≤35℃）。入院血压与术中最低体温之间存在显著相关性（r = 0.60；p < 0.001）。多元回归分析显示，患者的最低体温（p < 0.001）和创伤评分（TS）（p < 0.0015）与手术室失血相关，但腹部损伤严重程度评分（AISS）（p = 0.25）与之无关。28例创伤评分高（15或16）且AISS≥9的患者，当手术室温度维持在35℃以上与33℃ - 35℃时相比，失血量显著减少（540±580 mL对1820±1160 mL；p < 0.003）。这表明体温过低可能会加剧手术室失血，而与生理或解剖损伤程度无关。因此，体温过低在接受剖腹探查术治疗创伤的患者中很常见。创伤评分和术前休克的存在与术中体温过低的发生相关。损伤严重程度相似的体温过低患者失血量更大。在复苏和手术过程中预防并迅速纠正体温过低对于减少该患者群体的失血似乎极为重要。
