老年食管癌手术患者术后恢复过程中积极术中保暖与肺部并发症：一项随机试验的亚组分析
Aggressive intraoperative warming and postoperative pulmonary complications in elderly patients recovering from esophageal cancer surgery: sub-analysis of a randomized trial.
作者信息
Lu Xiaofei, Jiang Qiliang, Qiu Yuwei, Tang Wei, Sessler Daniel I, Wu Jingxiang
机构信息
Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Outcomes Research Consortium, Cleveland, OH, United States.
出版信息
Front Med (Lausanne). 2023 Jul 14;10:1157392. doi: 10.3389/fmed.2023.1157392. eCollection 2023.
BACKGROUND
Elderly patients having esophagectomies often become hypothermic which may promote complications. We tested the hypothesis that aggressive warming to a core temperature of 37°C reduces postoperative pulmonary complications (PPCs) in elderly patients having esophageal cancer resections.
METHODS
This study was a pre-defined sub-study of a multi-center, parallel group, superiority trial (PROTECT). Patients aged >65 years and having elective radical resection of esophageal cancer in a single center were randomly allocated into either aggressive warming group (target intraoperative core temperatures of 37°C) or routine thermal management group (target intraoperative core temperatures of 35.5°C). The primary endpoint was the incidence of PPCs. Secondary endpoints included duration of chest tube drainage and other postoperative complications.
RESULTS
A total of 300 patients were included in the primary analysis. PPCs occurred in 27 (18%) of 150 patients in the aggressive warming group and 31 (21%) of 150 patients in the routine thermal management group. The relative risk (RR) of aggressive versus routine thermal management was 0.9 (95% CI: 0.5, 1.4; = 0.56). The duration of chest drainage in patients assigned to aggressive warming was shorter than that assigned to routine thermal management: 4 (3, 5) days vs. 5 (4, 7) days; hazard ratio (HR) 1.4 [95% CI: 1.1, 1.7]; = 0.001. Fewer aggressively warmed patients needed chest drainage for more than 5 days: 30/150 (20%) vs. 51/150 (34%); RR:0.6 (95% CI: 0.4, 0.9; = 0.03). The incidence of other postoperative complications were similar between the two groups.
CONCLUSION
Aggressive warming does not reduce the incidence of PPCs in elderly patients receiving esophagectomy. The duration of chest drainage was reduced by aggressive warming. But as a secondary analysis of a planned sub-group study, these results should be considered exploratory.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showproj.aspx?proj=37099, ChiCTR1900022257.
背景
接受食管切除术的老年患者常出现体温过低，这可能会引发并发症。我们检验了以下假设：积极升温至核心体温37°C可降低老年食管癌切除术患者的术后肺部并发症（PPCs）。
方法
本研究是一项多中心、平行组、优效性试验（PROTECT）的预先定义的子研究。在单一中心，年龄>65岁且接受择期食管癌根治术的患者被随机分配至积极升温组（术中核心体温目标为37°C）或常规体温管理组（术中核心体温目标为35.5°C）。主要终点是PPCs的发生率。次要终点包括胸腔闭式引流持续时间和其他术后并发症。
结果
共有300例患者纳入主要分析。积极升温组150例患者中有27例（18%）发生PPCs，常规体温管理组150例患者中有31例（21%）发生PPCs。积极升温与常规体温管理的相对风险（RR）为0.9（95%CI：0.5，1.4；P = 0.56）。分配至积极升温组的患者胸腔引流持续时间短于分配至常规体温管理组的患者：4（3，5）天对5（4，7）天；风险比（HR）1.4[95%CI：1.1，1.7]；P = 0.001。积极升温组需要胸腔引流超过5天的患者更少：30/150（20%）对51/150（34%）；RR：0.6（95%CI：0.4，0.9；P = 0.03）。两组其他术后并发症的发生率相似。
结论
积极升温并不能降低接受食管切除术的老年患者PPCs的发生率。积极升温可缩短胸腔引流持续时间。但作为一项计划中的亚组研究的次要分析，这些结果应被视为探索性的。
临床试验注册
https://www.chictr.org.cn/showproj.aspx?proj=37099，ChiCTR1900022257。
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