Wódarski Bartłomiej, Chutkowski Radosław, Banasiewicz Jolanta, Moorthi Katarzyna, Wójtowicz Stanisław, Malec-Milewska Małgorzata, Iohom Gabriella
Department of Anaesthesiology and Intensive Care, Centre of Postgraduate Medical Education Clinical Hospital, Warsaw, Poland.
Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland.
Acta Anaesthesiol Scand. 2020 Jan;64(1):112-116. doi: 10.1111/aas.13462. Epub 2019 Sep 11.
Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear.
We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering.
Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R-square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P < .05] and STAI-X1 [(W) = 4.127 Exp(B) = 1.052 P < .05] were significant. In our model, the risk of shivering decreased by 44% with every previous delivery and increased by 5.2% with each 1-point increase in STAI-X1.
We failed to prove a strong correlation between the measured variables and shivering. Our findings, however, support the hypothesis, that to a limited extent, anxiety promotes shivering during CS.
剖宫产术（CS）在脊髓麻醉下出现寒战是一种常见现象。它不仅会通过增加耗氧量改变患者的生理状态，还会影响产妇的分娩体验。寒战被认为与术中体温过低有关，但风险因素和确切机制仍不清楚。
我们进行了一项前瞻性观察研究，以检查术中寒战的潜在风险因素，包括焦虑水平。招募了200名接受脊髓麻醉下择期剖宫产的患者。使用状态-特质焦虑量表（STAI）问卷评估产妇的焦虑水平。将年龄、体重、身高、体重指数、焦虑水平、既往分娩次数、感觉阻滞平面、教育程度、手术期间的温差和美国麻醉医师协会评分作为潜在风险因素进行调查。采用逐步逻辑回归分析评估寒战的预测因素。
分析了155名产妇的数据。寒战发生率为21.9%（34名产妇）。统计模型预测了8.5%的寒战发生率变异性（Nagelkerke决定系数R² = 0.085）。在所有测量变量中，只有既往分娩次数[（W）= 4.295，Exp（B）= 0.562，P <.05]和STAI-X1[（W）= 4.127，Exp（B）= 1.052，P <.05]具有统计学意义。在我们的模型中，每增加一次既往分娩，寒战风险降低44%，STAI-X1每增加1分，寒战风险增加5.2%。
我们未能证明所测量的变量与寒战之间存在强相关性。然而，我们的研究结果支持这样的假设，即在有限程度上焦虑会促进剖宫产术中的寒战。
