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刘雨薇, 梁诗琪, 范美龄, 等. 腹部手术患者围术期六种低体温特征与异体红细胞输注的关联性分析[J]. 四川大学学报（医学版）, 2023, 54(6): 1256-1262. DOI: 10.12182/20230960507
引用本文: 刘雨薇, 梁诗琪, 范美龄, 等. 腹部手术患者围术期六种低体温特征与异体红细胞输注的关联性分析[J]. 四川大学学报（医学版）, 2023, 54(6): 1256-1262. DOI: 10.12182/20230960507
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LIU Yuwei, LIANG Shiqi, FAN Meiling, et al. Correlation Between 6 Characteristics of Perioperative Hypothermia and Allogeneic Red Blood Cell Transfusion in Abdominal Surgery Patients[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(6): 1256-1262. DOI: 10.12182/20230960507
Citation: LIU Yuwei, LIANG Shiqi, FAN Meiling, et al. Correlation Between 6 Characteristics of Perioperative Hypothermia and Allogeneic Red Blood Cell Transfusion in Abdominal Surgery Patients[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(6): 1256-1262. DOI: 10.12182/20230960507
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腹部手术患者围术期六种低体温特征与异体红细胞输注的关联性分析

Correlation Between 6 Characteristics of Perioperative Hypothermia and Allogeneic Red Blood Cell Transfusion in Abdominal Surgery Patients

    摘要
  • 摘要:
      目的  探索腹部手术患者围术期多种体温特征与异体红细胞输注的关联性。
      方法  回顾性分析2019年10月–2021年7月于四川大学华西医院行腹部手术的患者资料，患者核心体温由穿戴式无线体温传感器围术期全程连续监测，计算进入手术室至麻醉结束后24 h内的体温最低值、体温最大跌幅、低体温持续时长占比、时间加权平均温度、36 ℃曲线下面积和37 ℃曲线下面积。采用限制性立方样条结合多因素logistic回归模型评估上述6种体温特征与围术期异体红细胞输注的关联。
      结果  共有3119例患者纳入研究，其中异体红细胞输注率为2.8%。限制性立方样条模型显示，异体红细胞输注与围术期体温最低值（Poverall=0.048）和36 ℃曲线下面积有关（Poverall=0.026），非线性检验无统计学意义；其他体温特征关联无统计学意义。根据模型结果取截点对体温特征分组，多因素logistic回归显示体温最低值<35.5 ℃（OR=2.47，95%CI：1.21~5.03）、36 ℃曲线下面积≥100 ℃·min（OR=2.24，95%CI：1.09~4.58）与围术期异体红细胞输注需求增加有关。
      结论  低体温与围术期异体红细胞输注需求增加有关，并且存在时间维度上的累积效应。针对出血风险高的患者应注意避免围术期体温过低、减少低体温的累积暴露量，以降低输血需求。

     

    Abstract:
      Objective  To explore the correlation between six characteristics of perioperative hypothermia and allogeneic red blood cell (RBC) transfusions in patients who underwent abdominal surgeries.
      Methods  Patients who underwent abdominal surgeries at West China Hospital, Sichuan University between October 2019 and July 2021 were retrospectively enrolled. A wearable wireless temperature sensor was used to continuously monitor the core body temperature of patients throughout the perioperative period. The perioperative temperature nadir, maximum temperature loss, percentage of time with hypothermia, time-weighted average temperature, area under the curve (AUC) at 36 ℃, and AUC at 37 ℃ were calculated for the period from entering the operation room to 24 hours after the end of anesthesia. The restricted cubic spline (RCS) and multiple logistic regression models were used to explore the correlation between these temperature characteristics and perioperative allogeneic RBC transfusions.
      Results  A total of 3119 patients were included in the study, with an allogeneic RBC transfusion rate of 2.8%. The RCS model showed that allogeneic RBC transfusion was associated with the perioperative temperature nadir (Poverall=0.048) and AUC at 36 ℃ (Poverall=0.026) and no statistical significance was found in the nonlinear test. The association between allogeneic RBC transfusions and other temperature characteristics was not statistically significant. According to the RCS model results, cut-off points were taken to form groups based on the body temperature characteristics. Multivariate logistic regression showed that the perioperative temperature nadir<35.5 ℃ (odds ratio OR=2.47, 95% confidence interval CI: 1.21-5.03) and AUC at 36 ℃≥100 ℃·min (OR=2.24, 95% CI:1.09-4.58) were associated with increased demand for allogeneic RBC transfusion.
      Conclusion  Hypothermia is associated with an increased need for perioperative allogeneic RBC transfusions and has a cumulative effect over time. For patients at high risk of bleeding, attention should be paid to the prevention of perioperative hypothermia and reduction in the cumulative exposure to hypothermia, thereby reducing the need for blood transfusion.

     

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