术中体温与术后谵妄之间的关联：一项回顾性观察研究。

Association between intraoperative body temperature and postoperative delirium: A retrospective observational study.

作者信息

Ju Jae-Woo, Nam Karam, Sohn Jin Young, Joo Somin, Lee Jaemoon, Lee Seohee, Cho Youn Joung, Jeon Yunseok

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

出版信息

J Clin Anesth. 2023 Aug;87:111107. doi: 10.1016/j.jclinane.2023.111107. Epub 2023 Mar 14.

DOI:10.1016/j.jclinane.2023.111107

PMID:36924749

Abstract

STUDY OBJECTIVE

The effect of perioperative body temperature derangement on postoperative delirium remains unclear. This study aimed to evaluate the association between intraoperative body temperature and postoperative delirium in patients having noncardiac surgery.

DESIGN

Single-center retrospective observational study.

SETTING

Tertiary university hospital.

PATIENT

Adult patients who had major noncardiac surgery under general anesthesia for at least two hours between 2019 and 2021.

INTERVENTIONS

Patients were classified into three groups according to their intraoperative time-weighted average body temperature: severe hypothermia (<35.0 °C), mild hypothermia (35.0 °C-36.0 °C), and normothermia (≥36.0 °C) groups.

MEASUREMENTS

The primary outcome was the risk of delirium occurring within seven days after surgery, which was compared using logistic regression analysis. A multivariable procedure was performed adjusting for potential confounders including demographics, history of hypertension, diabetes, atrial fibrillation or flutter, myocardial infarction, congestive heart failure, and stroke or transient ischemic attack, preoperative use of antidepressants and statins, preoperative sodium imbalance, high-risk surgery, emergency surgery, duration of surgery, and red blood cell transfusion. Cox regression analysis was also performed using the same covariates.

MAIN RESULTS

Among 27,674 patients analyzed, 5.5% experienced postoperative delirium. The incidence rates of delirium were 6.2% (63/388) in the severe hypothermia group, 6.4% (756/11779) in the mild hypothermia group, and 4.6% (712/15507) in the normothermia group. Compared with the normothermia group, the risk of delirium was significantly higher in the severe hypothermia (adjusted odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and mild hypothermia (1.15; 1.02-1.28) groups. The mild hypothermia group also had a significantly increased risk of cumulative development of delirium than the normothermia group (adjusted hazard ratio 1.14; 95% confidence interval, 1.03-1.26).

CONCLUSIONS

Intraoperative hypothermia (even mild hypothermia) was significantly associated with an increased risk of postoperative delirium.

摘要

研究目的

围手术期体温紊乱对术后谵妄的影响尚不清楚。本研究旨在评估非心脏手术患者术中体温与术后谵妄之间的关联。

设计

单中心回顾性观察研究。

地点

三级大学医院。

患者

2019年至2021年间接受全身麻醉下至少两小时的大型非心脏手术的成年患者。

干预措施

根据患者术中时间加权平均体温分为三组：严重低温（<35.0°C）、轻度低温（35.0°C - 36.0°C）和正常体温（≥36.0°C）组。

测量指标

主要结局是术后七天内发生谵妄的风险，采用逻辑回归分析进行比较。进行多变量分析以调整潜在混杂因素，包括人口统计学、高血压病史、糖尿病、心房颤动或扑动、心肌梗死、充血性心力衰竭、中风或短暂性脑缺血发作、术前使用抗抑郁药和他汀类药物、术前钠失衡、高风险手术、急诊手术、手术时间和红细胞输血。还使用相同的协变量进行Cox回归分析。

主要结果

在分析的27674例患者中，5.5%发生了术后谵妄。严重低温组谵妄发生率为6.2%（63/388），轻度低温组为6.4%（756/11779），正常体温组为4.6%（712/15507）。与正常体温组相比，严重低温组（调整后的优势比，1.43；95%置信区间，1.04 - 1.97）和轻度低温组（1.15；1.02 - 1.28）谵妄风险显著更高。轻度低温组谵妄累积发生风险也比正常体温组显著增加（调整后的风险比1.14；95%置信区间，1.03 - 1.26）。