摘要
383例患者中，119例术中体温低于36℃，低体温发生率为31.1%。单因素分析显示与低体温相关的因素包括：①术前因素：年龄≥45岁；②麻醉因素：丙泊酚用量、瑞芬太尼用量和麻醉时间；③手术因素：CO2注入量、术中冲洗量、静脉总入量、液体总出量和手术室时间。多因素Logistic回归分析显示术中冲洗量（O = 1.746，95%CI：1.079～2.826，P = 0.023）、静脉总入量（O = 2.554，95%CI：1.366～4.773，P = 0.003）和手术室时间（O = 2.058，95%CI：1.107～3.823，P = 0.022）为妇科腹腔镜术中低体温的独立危险因素。
因各种原因导致机体核心温度低于36℃的现象称为围手术期低体
本研究采用前瞻性研究。选取2018年10月－2019年6月就诊于本院妇科拟行腹腔镜手术的患者为研究对象，观察患者术中体温变化。本研究共观察妇科腹腔镜手术390例，排除甲亢病史2例、术中出血大于800 mL者2例和术中由腹腔镜转开腹手术者3例，最终纳入383例，患者平均年龄为（40.9±9.8）岁。其中，子宫+输卵管切除14例，子宫切除57例，输卵管切除78例，子宫肌瘤剔除201例，其他33例。患者麻醉平均时间为（117.6±51.8）min，手术室平均时间（139.2±54.5）min。发生术中低体温（ < 36℃）的患者119例，发生率为31.1%。本研究经过宁德市医院伦理委员会批准，所有同意参与研究的患者均签署知情同意书。
使用红外线耳温枪（生产厂家：博朗，型号：IRT 6520）测量鼓膜温度作为围手术期核心体温。入手术室时测量基础体温，麻醉后每30 min进行1次监测，出手术室前测量末次体温。手术室期间任意时间的核心体温低于36℃则定义为患者存在低体温。
采用自行设计的“妇科腹腔镜手术术中低体温资料收集表”进行资料收集，包括以下内容：①人口学和手术前参数：年龄、性别、身高、体重、BMI、基础体温、术前血红蛋白量（hemoglobin，Hb）、代谢性疾病史（甲亢）和入室状态等；②麻醉参数：麻醉前心率（heart rate，HR）、美国麻醉医师协会分级（American Society of Anesthesiologists，ASA）、麻醉开始时间、麻醉结束时间、麻醉药物和麻醉剂量等；③手术参数：患者进出手术室时间、术中失血量、术中冲洗量、术中静脉总入量和术中液体总出量等。
单因素分析显示：年龄≥45岁（P = 0.006）、丙泊酚用量 ≥ 260 mg（P = 0.017）、瑞芬太尼用量 ≥ 625 μg（P = 0.008）、麻醉时间 ≥ 90 min（P = 0.000）、CO2灌注量 ≥ 150 L（P = 0.001）、术中冲洗量 ≥ 1 000 mL（P = 0.003）、静脉总入量 ≥ 1 500 mL（P = 0.000）、液体总出量 ≥ 200 mL（P = 0.002）和手术室时间 ≥ 120 min（P = 0.000）与术中低体温相关。见表1。
手术室时间包含麻醉时间，所以仅保留手术室时间纳入多因素分析。将年龄、丙泊酚用量、瑞芬太尼用量、CO2灌注量、术中冲洗量、静脉总入量、液体总出量和手术室时间等变量纳入多因素Logistic回归分析，结果显示：术中冲洗量（O = 1.746，95%CI：1.079～2.826，P = 0.023）、静脉总入量（O = 2.554，95%CI：1.366～4.773，P = 0.003）和手术室时间（O = 2.058，95%CI：1.107～3.823，P = 0.022）为妇科腹腔镜术中低体温的独立危险因素。见
本研究显示，术中低体温组年龄 ≥ 45岁者为51.3%，高于无低温组的36.4%，两者比较，差异有统计学意义，可见年龄较高者易发生低体温。BILLETER
本研究的麻醉方式均为全身麻醉，使用的麻醉药物主要是右美托咪定、丙泊酚、舒芬太尼和瑞芬太尼，其中舒芬太尼使用量较少，主要为瑞芬太尼替代。单因素分析显示，影响术中低体温的麻醉药物因素有丙泊酚和瑞芬太尼。在手术过程中麻醉药物的使用不可或缺。有研
本文单因素分析显示，术中低体温与CO2灌注量、术中冲洗量、静脉总入量、液体总出量和手术室时间有关。其中，术中冲洗量、静脉总入量和手术室时间是影响术中低体温的独立危险因素。热量传递的方式有4种：辐射、传导、对流和蒸发。传导是指机体的热量直接传给与之接触的温度较低的物体，手术过程中传导是热量丢失的主要形式。一项关于产妇剖宫产术中低体温危险因素的研
本研究术中冲洗量超过1 000 mL的患者，低体温发生风险增大，与文
应用于围手术期低体温的非药物干预措施主要包括体外保温（增加盖被和使用保温毯）、体腔保温（输液加温等）和特殊保温（术中使用氨基酸）
本研究中，383例纳入患者有119例术中体温低于36℃，术中低体温发生率为31.1%。单因素分析显示：与妇科腹腔镜手术术中低体温相关的因素为年龄 ≥ 45岁、丙泊酚用量、瑞芬太尼用量、麻醉时间、CO2使用量、术中冲洗量、静脉总入量、液体总出量和手术室时间；多因素Logistic回归分析显示：术中冲洗量、静脉总入量和手术室时间是妇科腹腔镜手术术中低体温的独立危险因素。
综上所述，目前我国术中低体温发生率仍较高，术中导致低体温的危险因素复杂，因我国大多数医疗单位尚未在术中采用积极保温措施，所以有必要针对腹腔镜手术患者进行持续体温监测，及时发现术中低体温，识别低体温的危险因素，并尽可能地采取保温措施干预，在积极提高现代医疗护理质量的同时，也有利于促进患者术后快速康复、降低术后并发症发生率和提升患者远期生活质量。
（吴静 编辑）
参 考 文 献
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