胸腔镜手术与开胸手术患者术中体温变化及术后相关指标分析  

Analysis of intraoperative temperature changes and postoperative related indexes in patients undergoing thoracoscopic surgery and thoracotomy

作　　者：常鑫 李凌海[1] 陈玢[1] 魏碧玉 刘涛[1] 王春[1] 高广阔[1] 沈珊珊 刘伟[1] CHANG Xin;LI Linghai;CHEN Bin;WEI Biyu;LIU Tao;WANG Chun;GAO Guangkuo;SHEN Shanshan;LIU Wei(Department of Anesthesiology,Beijing Chest Hospital,Capital Medical University,Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;不详)

机构地区：[1]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所麻醉科,北京101149 [2]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所手术室,北京101149

出　　处：《中国临床研究》2025年第2期266-270,共5页Chinese Journal of Clinical Research

摘　　要：目的观察分析成人开胸手术与胸腔镜手术术中不同时间点体温变化的特点及术后相关指标变化。方法回顾性选取北京胸科医院2020年1月1日至2023年12月31日202例择期胸科手术患者作为研究对象,根据手术方式分为胸腔镜组102例和开胸组100例。入室后测量核心体温,患者入室(T_(0))、麻醉诱导(T1)、进胸(T_(2))和手术进行30 min(T_(3))、60 min(T_(4))、90 min(T_(5))、120 min(T_(6))及关胸(T_(7))时的鼻咽温,术后3 d体温变化,术前及术后1 d C-反应蛋白(CRP)水平、白细胞计数及中性粒细胞百分比。结果开胸组患者低体温发生率为79.00%(79/100),最低体温为33.9℃。Logistic回归分析显示,总输液量>2000 mL(OR=24.441,95%CI:2.936~203.481,P=0.003)和入室体温较低(OR=0.001,95%CI:0.001~0.071,P=0.002)是开胸组患者术中低体温的独立危险因素。胸腔镜组低体温发生率为60.78%(62/102),最低体温为34.2℃。Logistic回归分析显示,年龄>60岁(OR=5.146,95%CI:1.621~16.340,P=0.005)和入室体温较低(OR=0.003,95%CI:0.001~0.044,P=0.001)是胸腔镜组患者术中低体温的独立危险因素。开胸组患者术后1 d CRP水平及白细胞计数高于胸腔镜组(P<0.05)。两组患者术中体温存在时间效应(F=198.725,P<0.01)和交互效应(F=4.166,P=0.030)。术后体温存在时间效应(F=9.090,P<0.01)和交互效应(F=11.688,P<0.01)。结论总输液量>2000 mL和入室体温较低是开胸组患者术中低体温的独立危险因素,年龄>60岁和入室体温较低是胸腔镜组患者术中低体温的独立危险因素;与胸腔镜手术比较,开胸手术围术期体温下降程度更大,术后体温波动更大。Objective To observe and analyze the characteristics of temperature changes at different time points and the changes of postoperative indexes in adult thoracotomy and thoracoscopic surgery.Methods A retrospective analysis was used to select 202 patients with elective thoracic surgery admilted in Beijing Chest Hospital from January 1st,2020 to December 31st,2023,and they were divided into the thoracoscopic group(102 cases)and the thoracotomy group(100 cases)according to the surgical methods.The core body temperature was measured after admission.The nasopharyngeal temperature was measured at entry(T_(0)),induction of anesthesia(T_(1)),thoracic entrance(T_(2)),30 min after surgery(T_(3)),60 min after surgery(T_(4)),90 min after surgery(T_(5)),120 min after surgery(T_(6)),and thoracic closure(T_(7))of the patient.Changes of body temperature 3 days after operation was measured.Levels of C-reactive protein(CRP),white blood cell count and neutrophil percentage before and 1 day after surgery were measured.Results The incidence of hypothermia in the thoracotomy group was 79.00%(79/100),and the lowest body temperature was 33.9℃.Logistic regression analysis showed that total fluid intake>2000 mL(OR=24.441,95%CI:2.936-203.481,P=0.003)and low body temperature(OR=0.001,95%CI:0.001-0.071,P=0.002)were independent risk factors for intraoperative hypothermia in the thoracotomy group.The incidence of hypothermia in the thoracoscopic group was 60.78%(62/102),and the lowest body temperature was 34.2℃.Logistic regression analysis showed that age>60 years old(OR=5.146,95%CI:1.621-16.340,P=0.005)and low internal body temperature(OR=0.003,95%CI:0.001-0.044,P=0.001)were independent risk factors for intraoperative hypothermia in thoracoscopic patients.Anesthesia time,operation time and total infusion volume in thoracotomy group were higher than those in thoracoscopic group(P<0.05).The level of CRP and white blood cell count were increased 1 day after thoracotomy group(P<0.05).There was the time effect(F=198.725,P<0.01)and interaction e

关 键 词：胸腔镜手术 开胸手术 体温变化 围术期低体温 平均动脉压 炎症反应 

分 类 号：R61[医药卫生—外科学]