目的 探讨腹腔镜胃癌根治术患者术中体温变化情况，统计术中低体温发生率并分析相关影响因素。方法 选取2021年1月至2023年12月郑州大学第一附属医院收治190例接受腹腔镜胃癌根治术的胃癌患者，回顾性分析患者术中不同时点体温变化情况，依据《围手术期患者低体温防治专家共识》标准，即患者术中任一时点鼓膜温度＜36℃，统计术中低体温发生率，并分为低体温组(n=64例)和正常体温组(n=126例)，收集两组人口学资料、临床资料，行单因素及logistic回归模型多因素分析明确腹腔镜胃癌根治术患者术中低体温独立性风险因素。结果 190例腹腔镜胃癌根治术患者术中发生低体温64例，术中低体温发生率为33。68％，T0～T5时点体温分别是(36。65±0。14)℃、(36。41±0。18)℃、(36。27±0。21)℃、(36。15±0。32)℃、(36。40±0。17)℃及(36。58±0。12)℃，患者术中体温呈先下降后回升趋势，与T0时点比较，T1～T4时点术中体温均更低，差异有统计学意义(P＜0。05);除性别、合并高血压及糖尿病、ASA分级、术前贫血及低白蛋白血症、术中失血量、术中输血外，两组患者年龄、体质量指数(body mass index，BMI)、手术时间、术中补液量及术中冲洗量比较，差异有统计学意义(P＜0。05);经logistic回归模型多因素分析，影响腹腔镜胃癌根治术患者术中低体温发生独立性风险因素为年龄(OR:2。264;95％CI:1。195～4。289)、BMI(OR:1。723;95％CI:1。130～2。626)、手术时间(OR:4。669;95％CI:1。630～13。377)及术中补液量(OR:2。248;95％CI:1。143～4。420)。结论 腹腔镜胃癌根治术患者术中CO2气腹建立后60 min内体温下降明显，术中低体温发生率较高，应对高龄、低BMI、手术时间长及术中补液量多患者重点关注。
Study on intraoperative temperature changes and related factors in patients undergoing laparoscopic radical gastrectomy for gastric cancer
Objective To investigate the intraoperative temperature changes in patients with laparoscopic radical gastrectomy for gastric cancer,to make statistics on the incidence of intraoperative hypothermia and to analyze the related influencing fac-tors.Methods A retrospective case-control study was conducted to select 190 patients with gastric cancer who underwent laparoscopic radical gastrectomy admitted to the First Affiliated Hospital of Zhengzhou University from January 2021 to Decem-ber 2023.The temperature changes of patients at different points during the operation were analyzed.According to the Expert Consensus on Prevention and Treatment of Hypothermia in Perioperative Patients,that is,the temperature of the eardrum at any point during the operation was＜36℃.The incidence of intraoperative hypothermia was statistically analyzed and divided into hypothermia group(n=64 cases)and normal body temperature group(n=126 cases).Demographic data and clinical data of the two groups were collected and univariate and multivariate logistic regression models were used to determine the in-dependent risk factors of intraoperative hypothermia in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Results 64 of the 190 patients underwent laparoscopic radical gastrectomy had intraoperative hypothermia,the incidence of intraoperative hypothermia was 33.68％,the temperature at T0～T5 was(36.65±0.14)℃,(36.41±0.18)℃,(36.27±0.21)℃,(36.15±0.32)℃,(36.40±0.17)℃ and(36.58±0.12)℃,respectively.The temperature of patients during the operation showed a trend of first decreasing and then rising.The intraoperative body temperature was lower from T1 to T4(P＜0.05).In addition to gender,combined hypertension and diabetes,ASA grade,preoperative anemia and hypoalbumine-mia,intraoperative blood loss,and intraoperative blood transfusion,there were statistically significant differences in age,BMI,operative time,intraoperative fluid volume and intraoperative irrigation volume between the two groups(P＜0.05).Multivariate analysis of logistic regression model showed that the independent risk factor of intraoperative hypothermia in pa-tients undergoing laparoscopic radical gastrectomy was age(OR:2.264,95％CI:1.195-4.289),BMI(OR:1.723,95％CI:1.130-2.626),operation time(OR:4.669;95％CI:1.630-13.377)and intraoperative fluid supplementation(OR:2.248,95％CI:1.143-4.420).Conclusion The body temperature of patients undergoing laparoscopic radical gastrectomy de-creased significantly within 60 minutes after the establishment of CO2 pneumoperitoneum,and the incidence of intraoperative hypothermia was high,which should be paid special attention to patients with old age,low BMI,long operation time and large amount of intraoperative fluid.
NETL
NSTL
万方数据
