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术后重症监护患者的意外体温过低与死亡率:对5050例患者的回顾性审计

Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients.

作者信息

Karalapillai D, Story D A, Calzavacca P, Licari E, Liu Y L, Hart G K

机构信息

Department of Anaesthesia, Austin Health, Melbourne, Vic., Australia.

出版信息

Anaesthesia. 2009 Sep;64(9):968-72. doi: 10.1111/j.1365-2044.2009.05989.x.

Abstract

We proposed that many Intensive Care Unit (ICU) patients would be hypothermic in the early postoperative period and that hypothermia would be associated with increased mortality. We retrospectively reviewed patients admitted to ICU after surgery. We recorded the lowest temperature in the first 24 h after surgery using tympanic membrane thermometers. We defined hypothermia as < 36 degrees C, and severe hypothermia as < 35 degrees C. We studied 5050 consecutive patients: 35% were hypothermic and 6% were severely hypothermic. In-hospital mortality was 5.6% for normothermic patients, 8.9% for all hypothermic patients (p < 0.001), and 14.7% for severely hypothermic patients (p < 0.001). Hypothermia was associated with in-hospital mortality: OR 1.83 for each degree Celsius ( degrees C) decrease (95% CI: 1.2-2.60, p < 0.001). Given the evidence for improved outcome associated with active patient warming during surgery we suggest conducting prospective studies of active warming of patients admitted to ICU after surgery.

摘要

我们提出,许多重症监护病房(ICU)患者在术后早期会出现体温过低的情况,且体温过低与死亡率增加相关。我们回顾性地研究了术后入住ICU的患者。我们使用鼓膜温度计记录术后头24小时内的最低体温。我们将体温过低定义为低于36摄氏度,将严重体温过低定义为低于35摄氏度。我们研究了5050例连续患者:35%体温过低,6%严重体温过低。体温正常患者的院内死亡率为5.6%,所有体温过低患者为8.9%(p<0.001),严重体温过低患者为14.7%(p<0.001)。体温过低与院内死亡率相关:每降低1摄氏度(℃)的比值比为1.83(95%置信区间:1.2 - 2.60,p<0.001)。鉴于有证据表明术中积极为患者保暖可改善预后,我们建议对术后入住ICU的患者进行主动保暖的前瞻性研究。

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