子宫肌瘤切除术和子宫切除术后患者中，解释性发热与不明原因发热的比较。

Rybak Eli A, Polotsky Alex J, Woreta Tinsay, Hailpern Susan M, Bristow Robert E

Division of Reproductive Endocrinology and Infertility and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10461, USA.

Obstet Gynecol. 2008 May;111(5):1137-42. doi: 10.1097/AOG.0b013e31816baea8.

OBJECTIVE

To confirm that fever with localized findings is less prevalent among febrile postoperative myomectomy patients than it is among hysterectomy patients.

METHODS

Hospital records of 341 hysterectomy patients and 250 myomectomy patients were reviewed. Rate of overall febrile morbidity, proportion of fever with localized findings, proportion of febrile patients worked-up, and other perioperative parameters were recorded. Fever was prospectively defined both inclusively (temperature at least 38.0 degrees C occurring at least 4 hours postoperatively) and in standard fashion (temperature at least 38.0 degrees C after 24 hours postoperatively). A localized fever required a positive laboratory, radiologic, or clinical finding. Chi-square, Student t test, and multivariable logistic regression were used.

RESULTS

The proportion of patients who developed postoperative fever after at least 4 hours was identical between myomectomy and hysterectomy patients (39.2% compared with 39.3%, P=.98). However, the proportion of febrile myomectomy patients with localized findings was significantly lower than hysterectomy patients (14.3% compared with 31.3%, P=.003). Likewise, when comparing respective rates of overall and localized fever after at least 24 hours postoperatively, similar results were obtained. Multivariable analysis confirmed the lower likelihood of localized findings among febrile postoperative myomectomy patients compared with hysterectomy patients (odds ratio of localized fever 0.30, 95% confidence interval 0.12-0.75, P=.01). Additionally, obesity raised the likelihood of localized findings in each group by 6% per unit of body mass index (odds ratio 1.06, 95% confidence interval 1.01-1.10, P=.03).

CONCLUSION

Overall postoperative fever rates are similar, but myomectomy is independently associated with fewer localized fevers than hysterectomy. Given the relatively low likelihood of localized fever, clinicians may consider simplifying the fever workup of postoperative myomectomy patients.

LEVEL OF EVIDENCE

II.

目的

证实发热伴局部症状在子宫肌瘤切除术后发热患者中比在子宫切除术后发热患者中更为少见。

方法

回顾了341例子宫切除术患者和250例子宫肌瘤切除术患者的医院记录。记录总体发热发病率、发热伴局部症状的比例、接受检查的发热患者比例以及其他围手术期参数。前瞻性地将发热定义为广义的（术后至少4小时体温至少38.0摄氏度）和标准方式（术后24小时后体温至少38.0摄氏度）。局部发热需要实验室、影像学或临床检查结果呈阳性。采用卡方检验、学生t检验和多变量逻辑回归分析。

结果

子宫肌瘤切除术患者和子宫切除术患者术后至少4小时出现发热的患者比例相同（分别为%和39.3%，P = 0.98）。然而，有局部症状的发热子宫肌瘤切除术患者比例显著低于子宫切除术患者（分别为14.3%和31.3%，P = 0.003）。同样，在比较术后至少24小时的总体发热率和局部发热率时，也得到了类似结果。多变量分析证实，与子宫切除术患者相比，子宫肌瘤切除术后发热患者出现局部症状的可能性较低（局部发热比值比为0.%，95%置信区间为0.12 - 0.75，P = 0.01）。此外，肥胖使每组患者出现局部症状的可能性每单位体重指数增加6%（比值比为1.06，95%置信区间为1.01 - 1.10，P = 0.03）。