开腹手术中低体温的影响因素分析

目的探讨开腹手术中低体温的影响因素。方法回顾性分析2018年10月1日到2019年1月1日期间于四川大学华西医院行开腹手术的81例患者,比较低体温组和非低体温组的临床资料,并探索术中低体温的影响因素。结果 81例患者中,术中发生低体温32例。低体温组与非低体温组患者的性别、年龄、BMI、HGB、WBC计数、PLT计数、TB、AST、ALT、ALB、PT、手术时间、术后住院时间和并发症Clavien-Dindo分级比较差异均没有统计学意义(P>0.05),但2组的术中输液量、术中出血量和手术方式比较差异有统计学意义(P<0.05)。低体温组患者的术中输液量及术中出血量均高于非低体温组患者,且肝切除比例高于非低体温组。多因素分析结果显示,术中出血量、术中补液量和手术类型是术中低体温的影响因素(P<0.05)。结论开腹手术中低体温与术中出血量、术中补液量和手术方式有关。对于术中出血较少的患者,可通过限制术中输液量,以减少术中低体温的发生;而对于术中出血较多者,加温补液可能会降低术中低体温的发生率。

Analysis in the influencing factor of intraoperative hypothermia during laparotomy

Objective To investigate the influencing factor of intraoperative hypothermia during laparotomy.Methods A total of 81 patients underwent laparotomy in our hospital from October 1, 2018 to January 1, 2019 were enrolled. The difference of preoperative baseline data and surgical data between the hypothermia and non-hypothermia groups was compared, and the influencing factor of intraoperative hypothermia during laparotomy was explored.Results Of the 81 patients, 32 patients occurred hypothermia during operation. There were no significant differences in gender, age, BMI, HGB, WBC count, PLT count, TB, AST, ALT, ALB, PT, operation time, postoperative hospital stay, and Clavien-Dindo grade between the hypothermia group and the non-hypothermia group(P>0.05), but there were significant differences in intraoperative infusion volume, intraoperative blood loss, and surgical mode(P<0.05). The intraoperative infusion volume and intraoperative blood loss in the hypothermia group were higher than those in the non-hypothermia operation group, and the proportion of hepatectomy was higher than that in the non-hypothermia group. The multivariate analysis show that the intraoperative blood loss, intraoperative infusion volume, and kind of operation were the risk factors for the hypothermia during laparotomy(P<0.05). Conclusions Intraoperative hypothermia is related to intraoperative bleeding volume, intraoperative fluid infusion volume, and the kind of operation. Therefore, for patients with less bleeding, the intraoperative hypothermia can be reduced by limiting the volume of intraoperative fluid infusion.For those patients with more intraoperative bleeding, warming fluid infusion may reduce the incidence of intraoperative hypothermia.