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在接受全身麻醉的患者中,意外围手术期低体温的发生率及其危险因素分析。

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors.

机构信息

Department of Anesthesiology and Reanimation, Ministry of Health Yozgat City Hospital, Yozgat, Turkey.

Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey.

出版信息

Int J Clin Pract. 2021 Jun;75(6):e14103. doi: 10.1111/ijcp.14103. Epub 2021 Feb 28.

Abstract

BACKGROUND

Unintended perioperative hypothermia, defined as core body temperature less than 36°C, is closely related to many complications such as cardiovascular diseases, peroperative hemorrhagic diathesis and impairment of drug metabolism. Determination of the incidence of perioperative hypothermia and examination of risk factors may help to prevent hypothermia and its complications.

METHODS

We conducted a prospective, observational study of 2015 patients who underwent various operations under general anesthesia, and the risk factors of developing hypothermia were analysed.

RESULTS

The incidence of perioperative hypothermia was 78.6%. The incidence of hypothermia within 2 hours was 56.6%, and after 2 hours, it was 100%. Mean age was 49.36 ± 16.10, and 17.8% were over 65 years old. The mean body mass index (BMI) was 27.96 ± 3.94 kg/m ; 60.8% of the patients had American Society of Anesthesiologists (ASA) I score, 33.4% had ASA II and 5.8% had ASA III; 35.8% of the patients had co-morbidities. Intravenous and irrigation fluids were unwarmed; 99.9% of the patients were warmed passively, and only 0.1% of patients received active heating intraoperatively. The incidence of hypothermia was higher in overweight (BMI ≥ 25 kg/m ), elderly (>65 years) patients and those with co-morbidities. High American Society of Anesthesiologists (ASA) scores, grade 3-4 surgery, endoscopic surgery, duration of anesthesia >2 hours, infusion or irrigation >1000 mL significantly increased the incidence of hypothermia.

CONCLUSION

The incidence of perioperative hypothermia found was high. Important risk factors were found as prolonged duration of anesthesia and surgery, advanced age, overweight, high ASA scores, major surgeries, endoscopic operations and unwarmed fluid administration. High incidence may be reduced by raising awareness, considering fossible risk factors and following the recommendations of the guidelines on prevention of perioperative hypothermia.

摘要

背景

围手术期意外低体温是指核心体温低于 36°C,与心血管疾病、术中出血倾向和药物代谢受损等许多并发症密切相关。确定围手术期低体温的发生率并检查危险因素有助于预防低体温及其并发症。

方法

我们对 2015 例接受全身麻醉下各种手术的患者进行了前瞻性、观察性研究,并分析了发生低体温的危险因素。

结果

围手术期低体温发生率为 78.6%。2 小时内低体温发生率为 56.6%,2 小时后发生率为 100%。平均年龄为 49.36±16.10 岁,17.8%的患者年龄超过 65 岁。平均体重指数(BMI)为 27.96±3.94kg/m²;60.8%的患者为美国麻醉医师协会(ASA)Ⅰ评分,33.4%为 ASA Ⅱ评分,5.8%为 ASA Ⅲ评分;35.8%的患者有合并症。静脉输液和冲洗液未预热;99.9%的患者被动加热,仅 0.1%的患者术中接受主动加热。超重(BMI≥25kg/m²)、老年(>65 岁)和有合并症的患者低体温发生率较高。ASA 评分高、3-4 级手术、内镜手术、麻醉时间>2 小时、输液或冲洗液>1000mL 显著增加低体温发生率。

结论

发现围手术期低体温发生率较高。重要的危险因素是麻醉和手术时间延长、年龄较大、超重、ASA 评分高、大手术、内镜手术和未预热液体的应用。通过提高认识、考虑可能的危险因素并遵循预防围手术期低体温指南的建议,可能会降低高发生率。

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