麻醉后恢复室期间全身麻醉患者发生低体温的影响因素  

Risk factors for hypothermia in patients undergoing general anesthesia in the postanesthesia care unit

作　　者：孙亮[1] 高倩[1] 王广[1] 梁汉生[1] 安海燕[1] 何苗[1] 冯艺[1] Sun Liang;Gao Qian;Wang Guang;Liang Hansheng;An Haiyan;He Miao;Feng Yi(Department of Anesthesiology,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院麻醉科,北京100044

出　　处：《中华医学杂志》2021年第1期52-56,共5页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC2001905)。

摘　　要：目的:探讨麻醉后恢复室(PACU)内全身麻醉(全麻)患者低体温发生率及其影响因素。方法:收集2019年1月1日至12月31日北京大学人民医院PACU内的10 341例全麻患者资料。根据在PACU期间是否发生低体温,分为低体温组和非低体温组,采用倾向性评分匹配年龄和性别后,纳入低体温组336例,非低体温组336例。比较两组患者临床特征,采用多因素logistic回归模型分析PACU期间发生低体温的潜在影响因素。结果:2019年PACU内发生低体温339例,发生率3.3%。低体温组年龄(54.1±17.1)岁,男156例,女180例;非低体温组年龄(53.1±16.0)岁,男156例,女180例。两组患者年龄、性别、美国麻醉医师协会(ASA)分级、手术种类差异均无统计学意义(均 P>0.05)。与PACU期间非低体温组比较,低体温组患者体质指数(BMI)[(22.8±3.5)kg/m ^(2)比(24.7±4.2)kg/m^(2)]、基线体温[(36.3±0.5)℃比(36.5±0.5)℃]较低,麻醉时间[(4.4±1.6)h比(3.2±1.5)h]、手术时间[(3.1±1.4)h比(2.1±1.3)h]较长,术中出血量、输血量、输液量较多(均 P<0.001)。多因素logistic回归分析结果显示,出血量大(L)( OR=5.361,95% CI:2.863~10.037, P<0.001)、俯卧位手术( OR=3.653,95% CI:2.104~6.342, P<0.001)、麻醉时间长(h)( OR=1.421,95% CI:1.227~1.646, P<0.001)、全身麻醉+神经阻滞( OR=1.708,95% CI:1.026~2.843, P=0.039)是PACU期间低体温的独立危险因素,而高BMI( OR=0.849,95% CI:0.801~0.900, P<0.001)为独立保护因素。 结论:PACU期间全麻患者低体温仍较常见,需给予足够的重视,识别高危患者,针对低体温的危险因素采取积极的预防措施。Objective To investigate the incidence of hypothermia and its risk factors in patients after general anesthesia in the post anesthesia recovery unit(PACU).Methods A total of 10341 patients after general anesthesia in the PACU of Peking University People′s Hospital from January to December 2019 were retrospectively reviewed.According to whether hypothermia occurred in the PACU,the patients were divided into hypothermia group and non-hypothermia group.After propensity score matching based on age and gender,336 cases in hypothermia group and 336 cases in non-hypothermia group were finally included.The clinical characteristics of the two groups were compared,and the potential risk factors of hypothermia in the PACU were analyzed by multivariate logistic regression model.Results The incidence of hypothermia in PACU was 3.3%(339/10341).The age of hypothermia group was(54.1±17.1)years,with 156 males and 180 females;the age of non-hypothermia group was(53.1±16.0)years,with 156 males and 180 females.There was no statistically significant difference in age,gender,American Society of Anesthesiologists(ASA)classification and operation type between the two groups(all P>0.05).Compared with the non-hypothermia group,the body mass index(BMI)[(22.8±3.5)kg/m^(2) vs(24.7±4.2)kg/m^(2)]and baseline body temperature[(36.3±0.5)℃vs(36.5±0.5)℃]were lower,and anesthesia time[(4.4±1.6)h vs(3.2±1.5)h]and operation time[(3.1±1.4)h vs(2.1±1.3)h]were longer in hypothermia group.The amount of intraoperative bleeding,blood transfusion and intravenous fluid was larger in hypothermia group(all P<0.001).Multivariate logistic regression analysis showed that larger amount of blood loss(L)(OR=5.361,95%CI:2.863-10.037,P<0.001),prone position operation(OR=3.653,95%CI:2.104-6.342,P<0.001),longer anesthesia time(h)(OR=1.421,95%CI:1.227-1.646,P<0.001),and general anesthesia combined with regional nerve block(OR=1.708,95%CI:1.026-2.843,P=0.039)were independent risk factors of hypothermia in the PACU,and higher BMI(OR=0.849,95%CI:0.801-0.900,

关 键 词：麻醉 全身 麻醉后恢复室 低体温 危险因素 预防 

分 类 号：R614[医药卫生—麻醉学]