胸外科手术的围术期低温和患者结局的关系：单中心回顾性分析
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Association between perioperative hypothermia and patient outcomes after thoracic surgery：A single center retrospective analysis
背景与目的
麻醉引起的体温调节功能损害和暴露于低温环境是造成手术患者发生低体温的主要原因。神经轴阻滞导致的外周血管舒张更加重了低温。目前对全麻联合区域麻醉下行胸科手术患者围术期低温的研究较少。我们回顾了2006-2011年所有的胸科手术患者，研究有或无联合硬膜外麻醉下体温的发生率和程度，并评估其作用。
方 法
纳入了339例术中需升高室温的肺切除患者：197例为全麻联合硬膜外麻醉（GA+EPI），199例为全麻（GA）。经过数据分析明确体温（<36℃）和输血量、重症监护室（ICU）的住院时间、病房住院时间和院内死亡率之间的联系。
结 果
超过一半的胸外科手术患者发生了低温。诱导时间较长、体表面积较小和术中输液时间过长是导致围术期低温的独立危险因素。额外的硬膜外麻醉并没有增加体温的发生率，但降低了中心体温（临床意义不是很大的程度）。拟进行胸外科手术的患者在麻醉诱导前给予体温预热是有益的，可减少围术期低温的高发生率。
结 论
超过一半的胸外科手术患者发生了低温。诱导时间较长、体表面积较小和术中输液时间过长是导致围术期低温的独立危险因素。额外的硬膜外麻醉并没有增加体温的发生率，但降低了中心体温（临床意义不是很大的程度）。拟进行胸外科手术的患者在麻醉诱导前给予体温预热是有益的，可减少围术期低温的高发生率。
原始文献摘要
Emmert A, Gries G, Wand S, et al. Association between perioperative hypothermia and patient outcomes after thoracic surgery: A single center retrospective analysis.[J]. Medicine, 2018, 97(17):e0528.
Abstract:Hypothermia due to anaesthetic-induced impairment of thermoregulatory control and exposure to a cool environment is common in surgical patients. Peripheral vasodilation due to neuroaxial blockade may aggravate hypothermia. There is few data on perioperative hypothermia in patients undergoing thoracic surgery under combined general and regional anesthesia. We reviewed all thoracic surgical patients between 2006 and 2011 to determine the incidence and extent of hypothermia with or without an epidural anesthesia and evaluated its effect.Around 339 patients underwent lung resection procedures with intraoperative forced-air warming: 197 with general and epidural anesthesia (GA + EPI), 199 with general anesthesia alone (GA). Statistical analyses were performed to determine the association between hypothermia (T < 36°C) and transfusion requirements, length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and in hospital mortality.The overall incidence of hypothermia was 64.3%. Multivariate regression analysis revealed three significant risk factors for the development of hypothermia: long induction time (P = .011), small body surface area (P = .003), and application of more fluid intraoperatively (P < .001). Factors determining the extent of hypothermia were: receiving an open thoracotomy (P = .009), placement and use of an epidural catheter (P = .002), and a lower body mass index (BMI) (P < .001). Additional epidural anesthesia reduced core temperature by 0.26°C (95% CI -0.414 to -0.095°C, P < .05). There was no difference in transfusion requirements, ICU LOS or mortality between both groups. Hospital LOS was longer in patients with hypothermia.More than half of all thoracic patients suffered from hypothermia. A long induction time, small body surface area, and large intraoperative fluid application were independent risk factors for the development of perioperative hypothermia. Additional epidural anesthesia to general anesthesia did not increase the incidence of hypothermia but decreased body core temperature to an-albeit not clinically significant-degree. Patients scheduled for thoracic surgery will probably benefit from an additional period of prewarming prior to induction to reduce the high incidence of perioperative hypothermia.
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