Shirozu Kazuhiro, Umehara Kaoru, Ikeda Mizuko, Kammura Yutaro, Yamaura Ken
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Operating Rooms, Kyushu University Hospital, Fukuoka, Japan.
J Anesth. 2020 Jun;34(3):383-389. doi: 10.1007/s00540-020-02763-1. Epub 2020 Mar 21.
The incidence of postoperative shivering is known to be inversely associated with core body temperature. However, previous studies have pointed out that the threshold of shivering could be affected by peripheral temperature or anesthetic agents. These reports pointed specific drugs, though, anesthesia techniques have since advanced considerably. This study aimed to investigate factors associated with postoperative shivering in the context of the current body warming practice.
The institutional clinical research ethics committee of Kyushu University approved the study protocol (IRB Clinical Research number 2019-233). This retrospective study involved 340 patients who had undergone radical surgery for gynecological cancer treatment under general anesthesia at our center from December 2012 to June 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering.
Postoperative shivering developed in 109 out of 340 patients. After multivariate-adjusted logistic regression, the incidences of postoperative shivering decreased significantly with increasing patient age (OR = 0.96; 95%CI: 0.93-0.98; p = 0.0004). Volatile anesthesia technique was less inclined to shiver after surgery than TIVA (OR = 0.55; 95%CI: 0.30-0.99; p = 0.04). Acetaminophen was much less used in the shivering group than in the non-shivering group (OR = 0.49; 95%CI: 0.25-0.94; p = 0.03).
This study indicated that the development of shivering in patients receiving the anesthetic technique currently used in our hospital was associated with use of acetaminophen or volatile agents, and patient age.
已知术后寒战的发生率与核心体温呈负相关。然而，先前的研究指出，寒战阈值可能受外周温度或麻醉剂的影响。不过，这些报告指出了特定药物，此后麻醉技术有了很大进展。本研究旨在探讨在当前身体保暖措施背景下与术后寒战相关的因素。
九州大学机构临床研究伦理委员会批准了该研究方案（IRB临床研究编号2019 - 233）。这项回顾性研究纳入了2012年12月至2019年6月在本中心接受全身麻醉下妇科癌症根治手术的340例患者。进行逻辑回归分析以估计术后寒战发生率的比值比（OR）。
340例患者中有109例发生术后寒战。经过多变量调整的逻辑回归分析后，术后寒战的发生率随患者年龄增加而显著降低（OR = 0.96；95%CI：0.93 - 0.98；p = 0.0004）。与全凭静脉麻醉（TIVA）相比，挥发性麻醉技术术后寒战的倾向较小（OR = 0.55；95%CI：0.30 - 0.99；p = 0.04）。寒战组对乙酰氨基酚的使用远少于非寒战组（OR = 0.49；95%CI：0.25 - 0.94；p = 0.03）。
本研究表明，在接受我院目前使用的麻醉技术的患者中，寒战的发生与乙酰氨基酚或挥发性麻醉剂的使用以及患者年龄有关。
