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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 154 -161. doi: 10.3877/cma.j.issn.2095-5790.2022.02.011

论著

肩关节镜术中低体温情况的观察性研究
魏澜1, 王泓巍2, 杨仁豪3, 宋艳艳4, 刘敬锋3, 王蕾3, 王晓宁1, 庄澄宇3,†()   
  1. 1. 200025　上海交通大学医学院附属瑞金医院手术室
    2. 200025　上海交通大学医学院附属瑞金医院麻醉科
    3. 200025　上海交通大学医学院附属瑞金医院骨科
    4. 200025　上海交通大学医学院生物统计学教研室
  • 收稿日期:2022-03-12 出版日期:2022-05-05
  • 通信作者: 庄澄宇
  • 基金资助:
    上海卫生系统先进适宜技术推广项目(2019SY011); 国家自然科学基金青年项目(82102618); 国家自然科学基金面上向项目(32171317)

Perioperative hypothermia during shoulder arthroscopy surgery: An observational study

Lan Wei1, Hongwei Wang2, Renhao Yang3, Yanyan Song4, Jingfeng Liu3, Lei Wang3, Xiaoning Wang1, Chengyu Zhuang3,†()   

  1. 1. Department of Operation Room, Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital, Shanghai 200025, China
    2. Department of Anesthesiology, Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital, Shanghai 200025, China
    3. Department of Orthopedic, Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital, Shanghai 200025, China
    4. Department of Biostatistics, Clinical Research Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Received:2022-03-12 Published:2022-05-05
  • Corresponding author: Chengyu Zhuang
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引用本文：

魏澜, 王泓巍, 杨仁豪, 宋艳艳, 刘敬锋, 王蕾, 王晓宁, 庄澄宇. 肩关节镜术中低体温情况的观察性研究[J]. 中华肩肘外科电子杂志, 2022, 10(02): 154-161.

Lan Wei, Hongwei Wang, Renhao Yang, Yanyan Song, Jingfeng Liu, Lei Wang, Xiaoning Wang, Chengyu Zhuang. Perioperative hypothermia during shoulder arthroscopy surgery: An observational study[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2022, 10(02): 154-161.

目的

观察肩关节镜术中围手术期低体温的发生率以及影响因素。

方法

回顾性分析2020年6月至2020年9月以及2020年12月至2021年2月于本院治疗的161例肩关节镜手术患者，排除1例年龄过小、2例合并颈椎病、3例数据不全的患者，实际入组参与研究患者155例，其中左侧肩66例、右侧肩89例；男50例、女105例（男：女=1:2）；平均年龄（58.87±11.50）岁（19~79岁）。126例肩袖损伤，9例肩关节不稳定，1例肱骨大结节骨折，16例冻结肩，3例钙化性肌腱炎。记录患者的基本资料、手术时长、麻醉分级、麻醉方式、术中体温保护措施、手术室的温度，对这些数据进行统计学的分析，评估围手术期低体温的发生率以及危险因素。

结果

针对155例肩关节镜患者的资料分析结果可见手术开始时有43例患者的体温均处于低体温状态，112例患者处于正常范畴，低体温发生率为27.74%。而在手术结束时出现低体温状态的患者有62例，而93例患者处于正常范畴，术后的低体温发生率为40%。所有的低体温状态均处于轻度的围手术期低体温范畴。麻醉后出现低体温的患者中，性别和BMI的比值差异具有统计学意义，而术中及结束时出现低温的情况则与年龄、性别、手术时间、灌注量和保温措施相关。并且当手术时间超过90 min后，灌注液对核心体温的影响起到了主导作用。

结论

肩关节镜手术中多种因素与围手术期低体温相关，常温灌注液体也对核心体温起到一定的影响作用，导致围手术期低体温的发生。

关键词: 肩关节镜, 灌注液, 围手术期低体温
Background

There was much attention focused on the perioperative physiological states, and during the state, the hypothermia could significantly affect postoperative clinical outcomes. With the development of shoulder arthroscopy, the related perioperative physiological conditions are also continuously recognized. Still, few reports are on the influencing factors and clinical functions of perioperative hypothermia during shoulder arthroscopy. Objective Investigation of the perioperative hypothermia and factors that influence hypothermia in shoulder arthroscopy.

Methods

A total of 161 patients with shoulder arthroscopy treatment were retrospectively analyzed. The patient’s general information, operative time, ASA, anesthesia method, heat preservation measure and operating room temperature, etc., were recorded. These data and the incidence of hypothermia during the perioperative period and the risk factors were statistically analyzed.

Results

According to the data analysis results of 155 cases of shoulder arthroscopy, the incidence of hypothermia was 27.74% after general anesthesia, and the incidence of hypothermia postoperatively was 40%. The hypothermia showed a significant correlation with gender and BMI after anesthesia. The occurrence of hypothermia during and at the end of the operation is closely related to age, gender, operation time, irrigation fluid volume, and heat preservation measure. When the operation time exceeds 90 minutes, the irrigation fluid temperature has an essential role in changing the core temperature.

Conclusion

Various factors in shoulder arthroscopy are associated with perioperative hypothermia. The temperature of the irrigation fluid also has a particular effect on the core temperature, leading to the occurrence of hypothermia during the perioperative period.

Key words: Shoulder arthroscopy, Irrigation fluid, Perioperative hypothermia
表1 入组患者的基础信息[例（%）]
变量 结果
性别  
  男 50（32.26）
  女 105（67.74）
年龄（岁，±s） 58.87±11.50
BMI（±s） 23.78±3.01
ASA等级  
  I-II级 142（91.61）
  III级及以上 13（8.39）
损伤类型  
  肩袖损伤 126（81.29）
  肩关节不稳定 9（5.81）
  冻结肩 16（10.32）
  钙化性肌腱炎 3（1.94）
  骨折 1（0.64）
表2 不同时间点体温变化的患者基础分组信息
组别 例数 性别[例（%）] 患侧[例（%）] 年龄（岁，±s） 身高（cm，±s）
男 女 左 右 男 女 男 女
手术开始前低体温组 43 17（39.53） 26（60.47） 20（46.51） 23（53.49） 57.76±10.95 61.96±8.62 170.41±6.15 159.46±3.26
手术开始前无低体温组 112 33（29.46） 79（70.54） 46（41.07） 66（58.93） 48.33±14.20 62.49±8.13 171.97±6.17 160.05±4.88
手术结束低体温组 62 15（24.19） 47（75.81） 31（50.00） 31（50.00） 58.53±14.95 62.76±8.57 171.47±5.01 159.53±4.63
手术结束无低体温组 93 35（37.63） 58（62.37） 35（37.63） 58（62.37） 48.54±12.36 62.03±7.98 171.43±6.64 160.21±4.46
手术开始前正常/结束低体温组 32 6（18.75） 26（81.25） 12（37.50） 20（62.50） 55.50±17.31 63.77±7.72 172.83±3.65 159.92±5.59
手术开始前正常/结束正常组 80 27（31.25） 53（68.75） 32（40.00） 48（60.00） 46.74±13.27 61.87±8.33 171.78±6.64 160.11±4.56
组别 例数 体重（kg，±s） BMI（±s） 合并症[例（%）]
男 女 男 女 高血压 糖尿病 白内障 其他
手术开始前低体温组 43 66.35±10.38 58.13±7.06 22.89±3.88 22.87±2.76 9（20.93） 6（13.95） 2（4.65） 9（20.93）
手术开始前无低体温组 112 74.3±12.08 60.94±8.43 25.00±2.82 23.75±2.82 31（27.68） 9（8.04） 7（6.25） 17（15.18）
手术结束低体温组 62 70.23±11.09 59.05±8.47 23.95±4.15 23.19±3.03 19（50.00） 5（13.16） 3（7.89） 11（28.95）
手术结束无低体温组 93 72.18±12.54 61.21±7.86 24.42±2.98 23.81±2.63 24（46.15） 7（13.46） 6（11.54） 15（28.85）
手术开始前正常/结束低体温组 32 75.83±8.21 60.5±9.07 25.36±2.25 23.64±3.12 11（57.90） 1（0.05） 3（15.79） 4（21.05）
手术开始前正常/结束正常组 80 73.96±12.89 61.15±8.18 24.91±2.97 23.81±2.70 23（51.11） 5（11.11） 4（0.09） 13（28.90）
图1 术前体温与BMI人数百分比趋势
表3 影响手术开始时低体温发生的多因素Logistic回归模型结果及OR值
变量 P值 OR值 95% CI
患者年龄 0.07 1.04 0.998~1.08
性别（女） 0.04 0.41 0.17~0.97
20.5<BMI<24.5 0.03 0.32 0.11~0.90
BMI>24.5 0.01 0.23 0.08~0.66
有神经阻滞 0.96 0.98 0.47~2.06
图2 各体温测量时间的平均体温的变化趋势图
表4 混合效应模型分析各测量时间点的体温平均值的变化结果表
时间 估计系数 标准误 P值 95% CI
手术30 min -0.11 0.02 <0.001 -0.16~-0.07
手术60 min -0.13 0.03 <0.001 -0.18~-0.08
手术90 min -0.13 0.03 <0.001 -0.19~-0.07
手术120 min -0.15 0.05 0.01 -0.25~-0.04
手术150 min -0.46 0.10 <0.001 -0.66~-0.26
表5 影响手术中低体温发生的多因素分析结果
变量 估计系数 标准误 P值 95% CI
年龄组（50岁以上） -0.14 0.04 0.002 -0.22~-0.05
性别（女） -0.10 0.04 0.007 -0.17~-0.03
总灌注量分组        
  15~30 L -0.01 0.04 0.900 -0.09~0.08
  30 L以上 -0.09 0.04 0.035 -0.17~-0.01
有保温措施 0.20 0.05 <0.001 0.11~0.29
BMI 0.00 0.01 0.906 -0.01, 0.01
有神经阻滞 -0.05 0.03 0.128 -0.11, 0.01
表6 影响手术结束时低体温发生的多因素分析的模型结果及OR值
变量 P值 OR值 95% CI
手术时长（90 min以上） 0.01 3.30 1.31~8.76
年龄（50岁以上） 0.02 8.58 1.67~72.09
性别（女） 0.91 0.94 0.29~3.17
BMI 0.94 0.99 0.83~1.18
有保温措施 0.01 0.20 0.05~0.66
图3 手术时长与灌注量之间的散点分布图
表7 手术时长低于90 min的亚组
变量 P值 OR值 95% CI
手术时长 0.01 1.09 1.02~1.17
灌注总量 0.32 0.95 0.85~1.04
表8 手术时长高于90 min的亚组
变量 P值 OR值 95% CI
手术时长 0.71 0.99 0.96~1.02
灌注总量 0.008 1.09 1.02~1.18
[1]
Sessler DI. Complications and treatment of mild hypothermia[J] . Anesthesiology, 2001, 95（2）:531-543.
[2]
Sessler DI. Mild perioperative hypothermia[J] . N Engl J Med, 1997, 336（24）:1730-1737.
[3]
Schmied H, Kurz A, Sessler DI, et al. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty[J] . Lancet, 1996, 347（8997）:289-292.
[4]
Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group[J] . N Engl J Med, 1996, 334（19）:1209-1215.
[5]
Buhre W, Rossaint R. Perioperative management and monitoring in anaesthesia[J] . Lancet, 2003, 362（9398）:1839-1846.
[6]
Lopez M, Sessler DI, Walter K, et al. Rate and gender dependence of the sweating, vasoconstriction, and shivering thresholds in humans[J] . Anesthesiology, 1994, 80（4）:780-788.
[7]
Hymczak H, Golab A, Mendrala K, et al. Core Temperature Measurement-Principles of Correct Measurement, Problems, and Complications[J] . Int J Env Res Pub He, 2021, 18（20）: 10606.
[8]
Brauer A, Perl T, Wittkopp E, et al. Value of reflecting disposable insulation （Thermodrape） in preventing perioperative hypothermia[J] . AINS, 2000, 35（12）:756-762.
[9]
Abelha FJ, Castro MA, Neves AM, et al. Hypothermia in a surgical intensive care unit[J] . BMC Anesthesiol ,2005, 5:7.
[10]
Karalapillai D, Story DA, Calzavacca P, et al. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients[J] . Anaesthesia, 2009, 64（9）:968-972.
[11]
Hypothermia: prevention and management in adults having surgery[J] . National Institute for Health and Care Excellence，2016.
[12]
Long KC, Tanner EJ, Frey M, et al. Intraoperative hypothermia during primary surgical cytoreduction for advanced ovarian cancer: risk factors and associations with postoperative morbidity[J] . Gynecol Oncol, 2013, 131（3）:525-530.
[13]
Scholten R, Leijtens B, Kremers K,et al. The incidence of mild hypothermia after total knee or hip arthroplasty: A study of 2600 patients[J] . J Orthop, 2018, 15（2）:408-411.
[14]
Mendonca FT, Ferreira JDS, Guilardi VHF,et al. Prevalence of Inadvertent Perioperative Hypothermia and Associated Factors: A Cross-Sectional Study[J] . Ther Hypothermia Tem, 2021, 11（4）:208-215.
[15]
Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings[J] . Anesthesiology，1978, 49（4）:239-243.
[16]
Lim H, Kim B, Kim DC, et al. A comparison of the temperature difference according to the placement of a nasopharyngeal temperature probe[J] . Korean J Anesthesiol, 2016, 69（4）:357-361.
[17]
Rushing J. Responding to mild and moderate unintentional hypothermia[J] . Nursing, 2008, 38（11）:22.
[18]
Wetz AJ, Perl T, Brandes IF,et al. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients[J] . J Clin Anesth, 2016, 34:282-289.
[19]
Akers JL, Dupnick AC, Hillman EL,et al. Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study[J] . Aorn J, 2019, 109（6）:741-747.
[20]
Boddu C, Cushner J, Scuderi GR. Inadvertent Perioperative Hypothermia During Orthopedic Surgery[J] . Am J Orthop, 2018, 47（7）.
[21]
Kurz A, Plattner O, Sessler DI,et al. The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients[J] . Anesthesiology, 1993, 79（3）:465-469.
[22]
Kenney WL, Munce TA. Invited review: aging and human temperature regulation[J] . J Appl Physiol, 2003, 95（6）:2598-2603.
[23]
Fox RH, Woodward PM, Exton-Smith AN, et al. Body temperatures in the elderly: a national study of physiological, social, and environmental conditions[J] . Br Med J, 1973, 1（5847）:200-206.
[24]
DeGroot DW, Havenith G, Kenney WL. Responses to mild cold stress are predicted by different individual characteristics in young and older subjects[J] . J Appl Physiol, 2006, 101（6）:1607-1615.
[25]
Sagiroglu G, Ozturk GA, Baysal A, et al. Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries[J] . J Coll Physicians Surg Pak, 2020, 30（2）:123-128.
[26]
Collins S, Budds M, Raines C, et al. Risk Factors for Perioperative Hypothermia: A Literature Review[J] . J Perianesth Nurs, 2019, 34（2）:338-346.
[27]
Hooper VD, Chard R, Clifford T,et al. ASPAN’s Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second Edition[J] . J Perianesth Nurs, 2010, 25（6）:346-365.
[28]
Giuliano KK, Hendricks J. Inadvertent Perioperative Hypothermia: Current Nursing Knowledge[J] . Aorn J, 2017, 105（5）:453-463.
[29]
Fernandes LA, Braz LG, Koga FA, et al. Comparison of peri-operative core temperature in obese and non-obese patients[J] . Anaesthesia, 2012, 67（12）:1364-1369.
[30]
Kim YS, Lee JY, Yang SC, et al. Comparative study of the influence of room-temperature and warmed fluid irrigation on body temperature in arthroscopic shoulder surgery[J] . Arthroscopy, 2009, 25（1）:24-29.
[31]
Soysal GE, Ilce A, Erkol MH. Effect of "An Innovative Technology" Active Warming and Passive Warming on Unplanned Hypothermia During Perioperative Period: A Clinical Trial[J] . Ther Hypothermia Tem, 2018, 8（4）:216-224.
[32]
Breathett K, Mehta N, Yildiz V, et al. The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation[J] . Am J Emerg Med, 2016, 34（4）:722-725.
[33]
Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia[J] . Anesthesiology, 1995, 82（3）:662-673.
[34]
Torossian A.Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia[J] . Best Pract Res Clin Anaesthesiol, 2008, 22（4）:659-668.
[35]
Frank SM, Satitpunwaycha P, Bruce SR, et al. Increased myocardial perfusion and sympathoadrenal activation during mild core hypothermia in awake humans[J] . Clin Sci （Lond）, 2003, 104（5）:503-508.
[36]
Frank SM, Higgins MS, Breslow MJ, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial[J] . Anesthesiology, 1995, 82（1）:83-93.
[37]
Board TN, Srinivasan MS. The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery[J] . Arch Orthop Trauma Surg, 2008, 128（5）:531-533.
[38]
Parodi D, Valderrama J, Tobar C,et al. Effect of warmed irrigation solution on core body temperature during hip arthroscopy for femoroacetabular impingement[J] . Arthroscopy, 2014, 30（1）:36-41.
[39]
Steelman VM, Chae S, Duff J, et al. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis[J] . Arthroscopy, 2018, 34（3）:930-942.
[40]
Oh JH, Kim JY, Chung SW,et al. Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery[J] . Arthroscopy, 2014, 30（2）:159-164.
[41]
Lim SH, Lee W, Park J, et al. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery[J] . Korean J Anesthesiol, 2016, 69（4）:362-367.
[42]
Lee JH, Heo HJ, Kim YY, et al. The effect of interscalene brachial plexus block with propofol sedation on preventing perioperative hypothermia during arthroscopic shoulder surgery [J] . Korean J Anesthesiol, 2021, 74（1）:53-58.
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