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术中意外低体温的发生率及相关因素:一项横断面研究。

Prevalence of Inadvertent Perioperative Hypothermia and Associated Factors: A Cross-Sectional Study.

机构信息

Department of Anesthesiology, Hospital de Base do Distrito Federal, Brasília, Brazil.

Department of Anesthesiology, Hospital Universitário de Brasília, Brasília, Brazil.

出版信息

Ther Hypothermia Temp Manag. 2021 Dec;11(4):208-215. doi: 10.1089/ther.2020.0038. Epub 2021 Feb 1.

Abstract

Inadvertent perioperative hypothermia, defined as a body temperature <36.0°C, is a common outcome of anesthesia that can cause serious consequences to patients. The aim of this study is to determine the prevalence of inadvertent hypothermia among surgical procedures from two referral centers in Brazil and to identify sociodemographic, clinical, or surgery-related predictors of hypothermia. This is a cross-sectional study, conducted at two public hospitals in Brasília, Brazil. After the exclusion of 109 patients, 312 subjects (American Society of Anesthesiologists [ASA] physical status I-III) were enrolled from July 2016 through July 2018. The main outcome measures were the prevalence of hypothermia and its predictors. The mean age of the 312 patients was 43.2 (18.2) years (range 18-85 years), and 186 (59.6%) were female. The prevalence of inadvertent hypothermia was 56.7%. Predictors of hypothermia were perioperative chills ( = 0.026), patient's body temperature on arrival in the operating room ( < 0.001), diabetes ( < 0.001), ASA status III ( < 0.001), systolic blood pressure ( < 0.001), general anesthesia ( < 0.001), medical specialty ( < 0.001), fentanyl-based anesthesia ( = 0.002), and surgery time ( < 0.001). The multivariable model prediction model for hypothermia showed fairly good discrimination (area under the receiver operating characteristic: 79.0%, 95% confidence interval 68.0 to 80.1). Approximately 6 in 10 patients undergoing surgery developed inadvertent perioperative hypothermia. The risk of hypothermia is influenced by a myriad of factors that can be used in simple and low-cost predictive models with adequate discriminatory power.

摘要

术中意外低体温,定义为体温<36.0°C,是麻醉的常见后果,可给患者带来严重后果。本研究旨在确定巴西两个转诊中心手术中意外低体温的发生率,并确定低体温的社会人口学、临床或手术相关预测因素。这是一项横断面研究,在巴西巴西利亚的两家公立医院进行。排除 109 例患者后,于 2016 年 7 月至 2018 年 7 月期间纳入 312 例(美国麻醉医师协会 [ASA] 体格 I-III 级)患者。主要结局指标为低体温的发生率及其预测因素。312 例患者的平均年龄为 43.2(18.2)岁(范围 18-85 岁),186 例(59.6%)为女性。术中意外低体温的发生率为 56.7%。低体温的预测因素包括围手术期寒战(=0.026)、患者到达手术室时的体温(<0.001)、糖尿病(<0.001)、ASA 状态 III(<0.001)、收缩压(<0.001)、全身麻醉(<0.001)、医学专业(<0.001)、芬太尼为基础的麻醉(=0.002)和手术时间(<0.001)。低体温的多变量预测模型显示出相当好的区分度(受试者工作特征曲线下面积:79.0%,95%置信区间 68.0 至 80.1)。约 6 成手术患者发生术中意外围手术期低体温。低体温的风险受多种因素影响,这些因素可用于具有足够区分度的简单、低成本预测模型中。

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