术前不同营养状况对腹腔镜下胃肠肿瘤根治手术老年患者术中意外低体温的影响及其危险因素分析  

Effect of different preoperative nutritional statuses on intraoperative unexpected hypothermia in elderly patients with laparoscopic gastrointestinal tumor radical operation and its risk factors analysis

作　　者：杨玉春 胡玉萍 翁立阳 梁婷婷 戴体俊 YANG Yuchun;HU Yuping;WENG Liyang;LIANG Tingting;DAI Tijun(Department of Anesthesiology,Fourth Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210031,China;Teaching and Researching Section of Anesthesia Pharmacology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China)

机构地区：[1]南京医科大学第四附属医院麻醉科,南京210031 [2]徐州医科大学麻醉药理学教研室,江苏徐州221004

出　　处：《重庆医学》2024年第19期2907-2910,2915,共5页Chongqing Medical Journal

基　　金：国家自然科学基金项目(30872432);江苏省南京市卫生科技发展项目(YKK20250)。

摘　　要：目的分析术前不同营养状况对腹腔镜下胃肠肿瘤根治手术老年患者术中意外低体温的影响及其危险因素。方法回顾性分析2021年2月至2023年12月在南京医科大学第四附属医院行腹腔镜下胃肠肿瘤根治手术的282例老年患者的临床病例资料。采用微型营养状况评定简表(MNA-SF)评估患者术前营养状况,统计术中意外低体温发生情况,单因素和多因素logistic回归分析影响因素。结果282例患者中104例(36.88%)发生术中意外低体温,合并营养不良或营养不良风险患者术中意外低体温发生率明显高于营养状况正常患者(P<0.05)。多因素logistic回归分析显示,年龄≥70岁、BMI<18.5 kg/m^(2)、术前出现进行性体重下降、术前MNA-SF评分<12分、CO 2气腹时间>4 h和合并低白蛋白血症是腹腔镜下胃肠肿瘤根治手术老年患者发生术中意外低体温的独立危险因素(P<0.05),而术中使用加温仪主动保温是避免发生术中意外低体温的独立保护因素(P<0.05)。结论营养状况较差的老年患者行腹腔镜下胃肠肿瘤根治手术更容易发生术中意外低体温,其影响因素较多,应密切关注。Objective To analyze the effect of preoperative nutritional status on the intraoperative unexpected hypothermia in elderly patients with laparoscopic gastrointestinal tumor radical operation and its risk factors.Methods The clinical case data in 282 elderly patients with laparoscopic gastrointestinal tumor radical surgery in the Fourth Affiliated Hospital of Nanjing Medical University from February 2021 to December 2023 were analyzed retrospectively.The mini nutritional assessment short form(MNA-SF)was adopted to evaluate the preoperative nutritional status of the patients.The intraoperative unexpected hypothermia occurrence were statistically analyzed.The univariate and multivariate logistic regression was used to analyze the influencing factors.Results Among 282 patients,104 cases(36.88%)had unexpected hypothermia during operation.The incidence rate of intraoperative unexpected hypothermia in the patients with complicating malnutrition or malnutritional risk was significantly higher than that in the patients with normal nutritional status(P<0.05).The multivariate logistic regression analysis showed that the age≥70 years old,body mass index(BMI)<18.5 kg/m^(2),progressive weight loss appearance before surgery,preoperative MNA-SF score<12 points,CO 2 pneumoperitoneum time>4 h and complicating hypoalbuminemia were the independent risk factors for intraoperative unexpected hypothermia occurrence in the elderly patients with laparoscopic gastrointestinal tumor radical operation(P<0.05),while the use of heating device for initiatively maintaining temperature during surgery was the protective factor for avoiding intraoperative unexpected hypothermia occurrence(P<0.05).Conclusion The elderly patients with poor nutritional status undergoing laparoscopic gastrointestinal tumor radical surgery are more likely to develop unexpected hypothermia.There are many influencing factors,so close attention should be paid to.

关 键 词：营养状况 腹腔镜下胃肠肿瘤手术 老年患者 意外低体温 影响因素 

分 类 号：R614.2[医药卫生—麻醉学]