Frank S M, Fleisher L A, Breslow M J, Higgins M S, Olson K F, Kelly S, Beattie C
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
JAMA. 1997 Apr 9;277(14):1127-34.
To assess the relationship between body temperature and cardiac morbidity during the perioperative period.
Randomized controlled trial comparing routine thermal care (hypothermic group) to additional supplemental warming care (normothermic group).
Operating rooms and surgical intensive care unit at an academic medical center.
Three hundred patients undergoing abdominal, thoracic, or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease.
The relative risk of a morbid cardiac event (unstable angina/ischemia, cardiac arrest, or myocardial infarction) according to thermal treatment. Cardiac outcomes were assessed in a double-blind fashion.
Mean core temperature after surgery was lower in the hypothermic group (35.4+/-0.1 degrees C) than in the normothermic group (36.7+/-0.1 degrees C) (P<.001) and remained lower during the early postoperative period. Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group (1.4% vs 6.3%; P=.02). Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis (relative risk, 2.2; 95% confidence interval, 1.1-4.7; P=.04), indicating a 55% reduction in risk when normothermia was maintained. Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group (2.4% vs 7.9%; P=.04).
In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.
评估围手术期体温与心脏发病率之间的关系。
随机对照试验，比较常规体温护理（低温组）与额外的补充保暖护理（正常体温组）。
一所学术医疗中心的手术室和外科重症监护病房。
300例接受腹部、胸部或血管外科手术的患者，这些患者要么有冠状动脉疾病记录，要么有冠心病高风险。
根据体温治疗情况，发生心脏不良事件（不稳定型心绞痛/心肌缺血、心脏骤停或心肌梗死）的相对风险。以双盲方式评估心脏结局。
低温组术后平均核心体温（35.4±0.1℃）低于正常体温组（36.7±0.1℃）（P<0.001），且在术后早期仍较低。正常体温组围手术期心脏不良事件的发生率低于低温组（1.4%对6.3%；P=0.02）。多因素分析显示，低温是心脏不良事件的独立预测因素（相对风险，2.2；95%置信区间，1.1 - 4.7；P=0.04），这表明维持正常体温时风险降低了55%。正常体温组术后室性心动过速的发生率也低于低温组（2.4%对7.9%；P=0.0)。
在有心脏危险因素且接受非心脏手术的患者中，围手术期维持正常体温与心脏不良事件和室性心动过速的发生率降低相关。
