首页|老年营养不良患者全身麻醉下股骨近端防旋髓内钉内固定术中低体温因素分析

老年营养不良患者全身麻醉下股骨近端防旋髓内钉内固定术中低体温因素分析

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目的 分析全身麻醉下行股骨近端防旋髓内钉(PFNA)内固定术的老年营养不良患者术中低体温的发生情况及其危险因素.方法 选取全身麻醉下行PFNA内固定术的老年患者139例,术前1 d的营养状况评分为0~11分.对可能导致患者发生术中低体温的相关因素行单因素及多因素Logistic二元回归分析.结果 术前营养评分0~11分的139例老年患者中,有79例(56.83%)发生了术中低体温.单因素及多因素Logistic二元回归分析结果提示:年龄≥75岁、MNA-SF营养评分0~7分、BMI<18.5 kg/m2、全身麻醉时间≥2 h、术中冲洗液量≥1 000 mL及术中补液量≥1 000 mL是导致老年患者发生术中低体温的危险因素(OR>1,P<0.05),而术中使用加温毯保温是避免发生术中低体温的保护因素(OR<1,P<0.05).结论 术前营养不良的老年患者全身麻醉下行PFNA内固定术中低体温发生率较高,营养状况较差的患者更容易发生术中低体温,患者年龄较大、营养状况较差、BMI较低、全身麻醉时间较长、术中冲洗液量及补液量较多容易导致术中低体温的发生,而使用加温毯可以降低术中低体温的发生率.
Analysis of hypothermia factors for elderly patients with malnutrition during proximal femoral nail antirota-tion internal fixation under general anesthesia
Objective To analyze the incidence and risk factors of hypothermia in elderly patients with malnutrition during proximal femoral nail antirotation(PFNA)internal fixation under general anesthesia.Methods A total of 139 elderly patients underwent PFNA internal fixation under general anesthesia were selected,and the nutritional status scores 1 day before surgery ranged from 0 to 11 points.Univariate and multivariate Logistic binary regression analysis was performed to analyze the related factors that may lead to intraoperative hypothermia.Results Among 139 elderly patients with preoperative nutritional scores of 0 to 11 points,79 cases(56.83%)developed intraoperative hypothermia.The results of univariate and multivariate Logistic binary regression analysis suggested that age≥75 years old,mini nutritional assessment short form(MNA-SF)nutritional score 0 to 7 points,BMI<18.5 kg/m2,duration of general anesthesia≥2 hours,intraoperative flushing fluid volume≥1 000 mL and intraoperative fluid volume≥1 000 mL were the risk factors for the occurrence of intraoperative hypothermia in elderly patients(OR>1,P<0.05).The use of warm blanket insulation was the protective factor against the occurrence of intraoperative hypothermia(OR<1,P<0.05).Conclusion The incidence of intraoperative hypothermia during PFNA internal fixation under general anesthesia in elderly patients with mainutrition before operation is high,and patients with poor nutritional status are more likely to develop intraoperative hypothermia.Patients with older age,poor nutritional status,lower BMI,longer duration of general anesthesia,and more intraoperative flushing fluid volume and intraoperative fluid volume are likely to lead to intraoperative hypothermia.The use of warm blanket can reduce the incidence of intraoperative hypothermia.

malnutritionproximal femoral nail antirotationinternal fixationelderlyintraoperative hypothermiarisk factor

樊倩楠、严志勇、吴浩、刘晶莹、耿莹、戴体俊

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南京医科大学附属宿迁第一人民医院麻醉科,江苏 宿迁 223800

徐州医科大学麻醉药理学教研室,江苏 徐州 221004

营养不良 股骨近端防旋髓内钉 内固定术 老年 术中低体温 危险因素

国家自然科学基金江苏省妇幼健康科研项目

30872432F201753

2024

局解手术学杂志
重庆市解剖学会,第三军医大学

局解手术学杂志

CSTPCD
影响因子:1.063
ISSN:1672-5042
年,卷(期):2024.33(2)
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