Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59 Boulevard Pinel, 69500, Bron, France.
University of Lyon, Villeurbanne, France.
Can J Anaesth. 2017 Sep;64(9):919-927. doi: 10.1007/s12630-017-0912-2. Epub 2017 Jun 15.
Although perioperative hypothermia may increase maternal morbidity, active warming is infrequently performed to maintain normothermia during Cesarean delivery (CD). The aim of this prospective observational study was to determine the factors associated with maternal hypothermia in this setting.
Women scheduled for elective or emergency CD were consecutively included in this study from November 2014 to October 2015. Maternal temperature was measured using an infrared tympanic thermometer on the patient's arrival in the operating room, at skin incision, and at the end of skin suture. Maternal hypothermia was defined by tympanic temperature < 36°C at the end of skin suture. Univariate analysis was performed, followed by multivariate logistic regression analysis, in order to determine the factors associated with maternal hypothermia at the end of the surgery.
Three hundred fifty-nine women were included and analyzed during this study. The incidence of hypothermia was 23% (95% confidence interval, 18 to 27) among the total population included. According to multivariate analysis, obesity, oxytocin augmentation of labour, and use of active forced-air warming were associated with a decreased risk of maternal hypothermia, while maternal temperature < 37.1°C on arrival in the operating room, maternal temperature < 36.6°C at skin incision, and an infused volume of fluids > 650 mL were significantly associated with maternal hypothermia. Both goodness of fit and predictive value of multivariate analysis were high.
Several predictive factors for maternal hypothermia during CD were identified. These factors should be taken into account to help prevent maternal hypothermia during CD.
尽管围手术期低体温可能增加产妇发病率，但在剖宫产（CD）期间很少主动升温以维持正常体温。本前瞻性观察研究的目的是确定在这种情况下与产妇低体温相关的因素。
本研究连续纳入 2014 年 11 月至 2015 年 10 月期间择期或紧急 CD 的女性。患者到达手术室时、切开皮肤时和皮肤缝合结束时使用红外鼓膜温度计测量产妇体温。鼓膜温度在皮肤缝合结束时 < 36°C 定义为产妇低体温。进行单因素分析，然后进行多因素逻辑回归分析，以确定手术结束时与产妇低体温相关的因素。
本研究共纳入 359 名女性进行分析。总人群中低体温发生率为 23%（95%置信区间，18%至 27%）。根据多因素分析，肥胖、催产素增强分娩和使用主动强制空气加热与降低产妇低体温的风险相关，而到达手术室时产妇体温 < 37.1°C、皮肤切开时产妇体温 < 36.6°C 和输注液体量 > 650 mL 与产妇低体温显著相关。多因素分析的拟合优度和预测值均较高。
确定了一些与 CD 期间产妇低体温相关的预测因素。这些因素应考虑在内，以帮助预防 CD 期间产妇低体温。
