Walters Michael J, Tanios Marianne, Koyuncu Onur, Mao Guangmei, Valente Michael A, Sessler Daniel I
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, United States.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, United States.
J Clin Anesth. 2020 Aug;63:109758. doi: 10.1016/j.jclinane.2020.109758. Epub 2020 Mar 26.
Moderate hypothermia (e.g., 34.5 °C) causes surgical site infections, but it remains unknown whether mild hypothermia (34.6 °C-35.9 °C) causes infection. Therefore, the objective of this study was to evaluate the relationship between intraoperative time-weighted average core temperature and a composite of serious wound and systemic infections in adults having colorectal surgery over a range of near-normal temperatures.
Retrospective, single center study.
The operating rooms of the Cleveland Clinic Foundation from January 2005 to December 2014.
Adult patients having colorectal surgery at least 1 h in length who received both general anesthesia and esophageal core temperature monitoring.
INTERVENTION(S): Time weighted average intraoperative core temperature.
Our primary outcome was a composite of serious infections obtained from a surgical registry and billing codes. Average intraoperative esophageal temperatures and the composite of serious 30-day complications were assessed with logistic regression, adjusted for potential confounding factors.
A total of 7908 patients were included in the analysis. A 0.5 °C decrease in time-weighted average intraoperative core temperature ≤ 35.4 °C was associated with an increased odds of serious infection (OR = 1.38, P = .045); that is, hypothermia below 35.4 °C progressively worsened infection risk. Additionally, at higher core temperatures, the odds of serious infection increased slightly with each 0.5 °C increase in average temperature (OR = 1.10, P = .047).
Below 35.5 °C, hypothermia was associated with increased risk of serious infectious complications. Why composite complications increased at higher temperatures remains unclear, but the highest temperatures may reflect febrile patients who had pre-existing infections. Avoiding time-weighted average core temperatures <35.5 °C appears prudent from an infection perspective, but higher temperatures may be needed to prevent other hypothermia-related complications.
中度低温（如34.5°C）会导致手术部位感染，但轻度低温（34.6°C - 35.9°C）是否会导致感染尚不清楚。因此，本研究的目的是评估在接近正常体温范围内，接受结直肠手术的成年患者术中时间加权平均核心体温与严重伤口及全身感染综合情况之间的关系。
回顾性单中心研究。
2005年1月至2014年12月克利夫兰诊所基金会的手术室。
接受全身麻醉和食管核心体温监测、手术时长至少1小时的成年结直肠手术患者。
时间加权平均术中核心体温。
我们的主要结局是从手术登记和计费代码中获取的严重感染综合情况。采用逻辑回归评估平均术中食管温度和30天严重并发症综合情况，并对潜在混杂因素进行校正。
共有7908例患者纳入分析。时间加权平均术中核心体温≤35.4°C时，每降低0.5°C与严重感染几率增加相关（比值比[OR]=1.38，P = 0.045）；即低于35.4°C的低温会使感染风险逐渐恶化。此外，在较高核心体温时，平均温度每升高0.5°C，严重感染几率略有增加（OR = 1.10，P = 0.047）。
低于35.5°C时，低温与严重感染并发症风险增加相关。高温时综合并发症为何增加尚不清楚，但最高温度可能反映了已有感染的发热患者。从感染角度来看，避免时间加权平均核心体温<35.5°C似乎是谨慎的做法，但可能需要更高温度来预防其他低温相关并发症。
