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[麻醉后护理单元术后体温过低的危险因素:一项前瞻性预后初步研究]

[Risk factors for postoperative hypothermia in the post-anesthetic care unit: a prospective prognostic pilot study].

作者信息

Mendonça Fabrício Tavares, Lucena Marcelo Cabral de, Quirino Raul Silva, Govêia Catia Sousa, Guimarães Gabriel Magalhaes Nunes

机构信息

Hospital de Base do Distrito Federal (HBDF), Departamento de Anestesiologia, Brasília, DF, Brasil.

Hospital de Base do Distrito Federal (HBDF), Departamento de Anestesiologia, Brasília, DF, Brasil.

出版信息

Braz J Anesthesiol. 2019 Mar-Apr;69(2):122-130. doi: 10.1016/j.bjan.2018.10.001. Epub 2019 Jan 23.

Abstract

BACKGROUND

Hypothermia occurs in up to 20% of perioperative patients. Systematic postoperative temperature monitoring is not a standard of care in Brazil and there are few publications about temperature recovery in the postoperative care unit.

DESIGN AND SETTING

Multicenter, observational, cross-sectional study, at Hospital de Base do Distrito Federal and Hospital Materno Infantil de Brasília.

METHODS

At admission and discharge from postoperative care unit, patients undergoing elective or urgent surgical procedures were evaluated according to tympanic temperature, vital signs, perioperative adverse events, and length of stay in postoperative care unit and length of hospital stay.

RESULTS

78 patients, from 18 to 85 years old, were assessed. The incidence of temperatures <36 °C at postoperative care unit admission was 69.2%. Spinal anesthesia ( < 0.0001), cesarean section ( = 0.03), and patients who received morphine ( = 0.005) and sufentanil ( = 0.003) had significantly lower temperatures through time. During postoperative care unit stay, the elderly presented a greater tendency to hypothermia and lower recovery ability from this condition when compared to young patients ( < 0.001). Combined anesthesia was also associated to higher rates of hypothermia, followed by regional and general anesthesia alone ( < 0.001).

CONCLUSION

In conclusion, this pilot study showed that perioperative hypothermia is still a prevalent problem in our anesthetic practice. More than half of the analyzed patients presented hypothermia through postoperative care unit admission. We have demonstrated the feasibility of a large, multicenter, cross-sectional study of postoperative hypothermia in the post-anesthetic care unit.

摘要

背景

高达20%的围手术期患者会出现体温过低的情况。在巴西,术后系统的体温监测并非护理标准,且关于术后护理单元体温恢复的出版物较少。

设计与地点

在巴西联邦区基础医院和巴西利亚母婴医院进行的多中心、观察性横断面研究。

方法

在术后护理单元入院和出院时,对接受择期或急诊手术的患者进行鼓膜温度、生命体征、围手术期不良事件以及术后护理单元住院时间和住院总时长的评估。

结果

共评估了78例年龄在18至85岁之间的患者。术后护理单元入院时体温<36°C的发生率为69.2%。脊髓麻醉(<0.0001)、剖宫产(=0.03)以及接受吗啡(=0.005)和舒芬太尼(=0.003)的患者体温随时间显著降低。在术后护理单元住院期间,与年轻患者相比,老年人出现体温过低的倾向更大,且从这种情况中恢复的能力更低(<0.001)。联合麻醉也与更高的体温过低发生率相关,其次是单独的区域麻醉和全身麻醉(<0.001)。

结论

总之,这项初步研究表明围手术期体温过低在我们的麻醉实践中仍然是一个普遍存在的问题。超过一半的分析患者在术后护理单元入院时出现体温过低。我们已经证明了在麻醉后护理单元进行一项关于术后体温过低的大型、多中心横断面研究的可行性。

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