Janczyk Randy J, Howells Greg A, Bair Holly A, Huang Raywin, Bendick Phillip J, Zelenock Gerald B
Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
Vasc Endovascular Surg. 2004 Jan-Feb;38(1):37-42. doi: 10.1177/153857440403800104.
Hypothermia is known to significantly increase mortality in trauma patients, but the effect of hypothermia on outcomes in ruptured abdominal aortic aneurysms (RAAA) has not been evaluated. The authors reviewed their experience from 1990 to 1999 in 100 consecutive patients who presented with RAAA and survived at least to the operating room for surgical treatment. There were 70 men and 30 women, with a mean overall age of 74 +/-8 years. Overall mortality was 47%. Univariate ANOVA (analysis of variants) showed significant correlation with mortality for decreased intraoperative temperature, decreased intraoperative systolic blood pressure, increased intraoperative base deficit, increased blood volume transfused, increased crystalloid volume (all p < 0.001); decreased preoperative hemoglobin (p = 0.015); and increased age (p = 0.026). Patient sex, initial preoperative temperature, preoperative systolic blood pressure, and operating room time were not correlated with mortality in the univariate analysis. Using these same clinical variables, multiple logistic regression analysis showed only 2 factors independently correlated with mortality: lowest intraoperative temperature (p = 0.006) and intraoperative base deficit (p = 0.009). The mean lowest temperature for survivors was 35 +/-1 degrees C and for nonsurvivors 33 +/-2 degrees C (p < 0.001). When patients were grouped by lowest intraoperative temperature, those whose temperature was < 32 degrees C (n = 15) had a mortality rate of 91%, whereas patients with a temperature between 32 and 35 degrees C (n = 50) had a mortality rate of 60%. In the group that remained at or > 35 degrees C (n = 35) the mortality rate was only 9%. A nomogram of predicted mortality versus temperature was constructed from these data and showed that for temperatures of 36, 34, and 32 degrees C the predicted mortality was 15%, 49%, and 84%, respectively. The authors conclude that hypothermia is a strong independent contributor to mortality in patients with ruptured abdominal aortic aneurysms and that very aggressive measures to prevent hypothermia are warranted during the resuscitation and treatment of these patients.
已知体温过低会显著增加创伤患者的死亡率，但体温过低对腹主动脉瘤破裂（RAAA）患者预后的影响尚未得到评估。作者回顾了他们在1990年至1999年期间对100例连续出现RAAA且至少存活至手术室接受手术治疗患者的经验。其中男性70例，女性30例，平均总年龄为74±8岁。总体死亡率为47%。单因素方差分析（变异分析）显示，术中体温降低、术中收缩压降低、术中碱剩余增加、输血量增加、晶体液量增加（所有p<0.001）；术前血红蛋白降低（p = 0.015）；以及年龄增加（p = 0.026）与死亡率显著相关。在单因素分析中，患者性别、术前初始体温、术前收缩压和手术室时间与死亡率无关。使用这些相同的临床变量，多因素逻辑回归分析显示只有两个因素与死亡率独立相关：最低术中体温（p = 0.006）和术中碱剩余（p = 0.009）。幸存者的平均最低体温为35±1℃，非幸存者为33±2℃（p<0.001）。当根据最低术中体温对患者进行分组时，体温<32℃的患者（n = 15）死亡率为91%，而体温在32至35℃之间的患者（n = 50）死亡率为60%。体温保持在或高于35℃的组（n = 35）死亡率仅为9%。根据这些数据构建了预测死亡率与体温的列线图，结果显示，对于36℃、34℃和32℃的体温，预测死亡率分别为15%、49%和84%。作者得出结论，体温过低是腹主动脉瘤破裂患者死亡率的一个强有力的独立影响因素，在这些患者的复苏和治疗过程中，有必要采取非常积极的措施来预防体温过低。
