Sumer Baran D, Myers Larry L, Leach Joseph, Truelson John M
Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9035, USA.
Arch Otolaryngol Head Neck Surg. 2009 Jul;135(7):682-6. doi: 10.1001/archoto.2009.65.
To determine if intraoperative hypothermia correlates with perioperative complications in patients undergoing head and neck surgery with regional or free flap reconstructions.
Retrospective medical chart review.
Academic tertiary care hospital.
A sample of 136 patients who underwent ablative surgery for head and neck cancer and subsequently required reconstruction with free tissue or a regional flap in the last 10 years.
Rate of early (within 3 weeks of surgery) perioperative complications and its correlation with patient hypothermia (core body temperature, <35 degrees C).
There were 43 patients with complications. Two patients died. Complications included 10 partial or total flap losses, 9 hematomas, 8 episodes of pneumonia, 7 fistulas, 7 wound infections, 5 wound breakdowns, and 2 cerebrospinal fluid leaks. Factors that did not correlate with complications included having received prior chemotherapy (P = .84), having stage IV cancer (P = .16), sex (P = .43), tobacco use (P = .58), prior radiotherapy (P = .30), the presence of comorbidities (P = .43), age (P = .27), length of surgery (P = .63), and the use of blood products perioperatively (P = .73). Patients who were hypothermic had a significantly higher rate of complications that normothermic patients (P = .002). Stepwise logistic regression analysis identified intraoperative hypothermia as a significant independent predictor for the development of early perioperative complications (odds ratio, 5.122; 95% confidence interval, 1.317-19.917).
Intraoperative hypothermia in head and neck surgery is correlated with perioperative complications. Maintaining normothermia through aggressive warming may decrease the incidence of perioperative morbidity for these patients.
确定在接受头颈手术并行区域或游离皮瓣重建的患者中，术中低体温是否与围手术期并发症相关。
回顾性病历审查。
学术性三级医疗中心。
选取过去10年中因头颈癌接受切除手术且随后需要游离组织或区域皮瓣重建的136例患者作为样本。
早期（术后3周内）围手术期并发症发生率及其与患者低体温（核心体温<35摄氏度）的相关性。
43例患者出现并发症。2例患者死亡。并发症包括10例部分或全部皮瓣丢失、9例血肿、8例肺炎、7例瘘管、7例伤口感染、5例伤口裂开和2例脑脊液漏。与并发症无关的因素包括曾接受化疗（P = 0.84）、患有IV期癌症（P = 0.16）、性别（P = 0.43）、吸烟（P = 0.58）、曾接受放疗（P = 0.30）、存在合并症（P = 0.43）、年龄（P = 0.27）、手术时长（P = 0.63）以及围手术期使用血制品（P = 0.73）。低体温患者的并发症发生率显著高于体温正常的患者（P = 0.002）。逐步逻辑回归分析确定术中低体温是早期围手术期并发症发生的显著独立预测因素（比值比，5.122；95%置信区间，1.317 - 19.917）。
头颈手术中的术中低体温与围手术期并发症相关。通过积极升温维持正常体温可能会降低这些患者围手术期发病的发生率。
