风险预警干预程序对老年全麻手术患者术中低体温及寒战发生风险的影响

陈姿妃; 项光恒; 吴崇崇

doi:10.16766/j.cnki.issn.1674-4152.004187

风险预警干预程序对老年全麻手术患者术中低体温及寒战发生风险的影响

doi: 10.16766/j.cnki.issn.1674-4152.004187

1.
温州医科大学附属第二医院手术室，浙江温州 325000
2.
温州医科大学附属第二医院创伤骨科

基金项目:

浙江省医药卫生科技计划项目 2023RC051

详细信息

通讯作者:
陈姿妃，E-mail：2429743773@qq.com

中图分类号: R472.3 R614.2
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出版历程
- 收稿日期: 2024-09-22
- 网络出版日期: 2025-11-17

Analysis of the influence of a risk early warning intervention program on the incidence of hypothermia and shivering in elderly patients undergoing general anesthesia

1.
Operating Room of the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的老年膝关节置换术患者是术中低体温及寒战发生的高风险人群，因此，降低老年膝关节置换术患者术中低体温及寒战的发生具有重要意义。为此，本研究纳入全麻下老年膝关节置换术患者，探讨风险预警干预程序对降低患者术中低体温及寒战发生风险的作用。方法采用随机数字表法将2023年12月—2024年5月温州医科大学附属第二医院100例老年全麻膝关节置换术患者随机分为对照组(采用常规保温干预)和观察组(采用风险预警干预程序保温干预)，每组50例。比较2组患者围手术期体温变化，术中低体温及寒战的发生情况以及应激反应、凝血功能水平。结果观察组术中低体温发生率(24.00%，12/50)及寒战发生率(2.00%, 1/50)均低于对照组[48.00%(24/50)、18.00%(9/50)，P < 0.05]；2组患者入室后、麻醉诱导后、手术开始时体温比较，差异均无统计学意义(P>0.05)，手术15 min、手术30 min、手术结束时、术后15 min时观察组体温均高于对照组(P < 0.05)；术后，观察组促肾上腺皮质激素为(46.80±8.93)pg/mL，促肾上腺皮质激素释放激素为(24.59±5.13)ng/mL，均低于对照组[(51.38±10.37)pg/mL、(28.15±6.36)ng/mL, P < 0.05]；观察组活化部分凝血活酶时间、凝血酶原时间、血浆凝血酶时间均高于对照组，纤维蛋白原低于对照组(P < 0.05)。结论风险预警干预程序的保温干预应用于全麻下老年膝关节置换术患者中能有效维持患者术中体温稳定，降低术中低体温及寒战的发生率，并能减轻应激反应，维持凝血功能稳定。
- 老年 /
- 全麻 /
- 手术 /
- 风险预警干预程序 /
- 低体温 /
- 寒战
Abstract: Objective Elderly patients undergoing knee replacement surgery are at a high risk of intraoperative hypothermia and shivering. Reducing the incidence of hypothermia and shivering in elderly patients undergoing knee replacement is of significant clinical importance. Therefore, this study aimed to explore whether a risk early warning intervention program can effectively reduce the occurrence of intraoperative hypothermia and shivering during operation in elderly patients undergoing knee replacement under general anesthesia. Methods A total of 100 elderly patients undergoing general anesthesia in the Second Affiliated Hospital of Wenzhou Medical University from December 2023 to May 2024 were randomly divided into the control group (routine insulation intervention) and the observation group (risk early warning intervention procedure), with 50 cases in each group. Perioperative body temperature, incidence of hypothermia and shivering during operation, stress response markers, and coagulation function were compared between the two groups. Results The incidence of intraoperative hypothermia (24.00%, 12/50) and the incidence of shivering (2.00%, 1/50) were lower than in the control group [48.00% (24/50), 18.00% (9/50), P < 0.05], respectively. There were no significant differences in body temperature between the two groups upon operating room entry, after induction of anesthesia, or at the beginning of surgery (P>0.05). At 15 minutes, 30 minutes, at the end of surgery, and 15 minutes after surgery, body temperature was significantly higher in the observation group (P < 0.05). After surgery, the levels of ACTH [(46.80±8.93) pg/mL] and CRH [(24.59±5.13) ng/mL] in the observation group were lower than in the control group [(51.38±10.37) pg/mL, (28.15±6.36) ng/mL, P < 0.05]. Additionally, the observation group showed higher levels of APTT, PT, and TT, and lower levels of FIB compared to the control group (P < 0.05). Conclusion A risk early warning intervention program can effectively maintain the intraoperative body temperature in elderly patients undergoing knee replacement under general anesthesia, reduce the incidence of intraoperative hypothermia and shivering, attenuate the stress response, and support the stability of blood coagulation function.
- Old age /
- General anesthesia /
- Surgery /
- Risk early warning intervention procedures /
- Hypothermia /
- Shivering

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表 1 2组老年全麻膝关节置换术患者一般资料比较

Table 1. Comparison of general data of two groups of elderly patients undergoing knee arthroplasty under general anesthesia

组别	例数	年龄(x±s, 岁)	性别[例(%)]		病变位置[例(%)]		ASA分级[例(%)]		手术时间(x±s, min)	麻醉时间(x±s, min)	输液量(x±s, mL)
组别	例数	年龄(x±s, 岁)	男性	女性	左侧	右侧	Ⅰ级	Ⅱ级	手术时间(x±s, min)	麻醉时间(x±s, min)	输液量(x±s, mL)
对照组	50	69.45±5.71	29(58.00)	21(42.00)	23(46.00)	27(54.00)	8(16.00)	42(84.00)	72.48±10.22	83.12±8.55	749.89±47.28
观察组	50	71.34±8.67	24(48.00)	26(52.00)	30(60.00)	20(40.00)	13(26.00)	37(74.00)	76.74±12.61	85.21±9.74	754.69±52.21
统计量		1.287^a	1.004^b		1.967^b		1.507^b		1.856^a	1.140^a	0.482^a
P值		0.202	0.316		0.161		0.220		0.067	0.257	0.631
注：^a为t值，^b为χ²值。

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表 2 2组老年全麻膝关节置换术患者术中低体温及寒战发生情况比较[例(%)]

Table 2. Comparison of intraoperative hypothermia and chills in two groups of elderly patients undergoing knee arthroplasty under general anesthesia[cases(%)]

组别	例数	低体温	寒战
对照组	50	24(48.00)	9(18.00)
观察组	50	12(24.00)	1(2.00)
χ²值		6.250	7.111
P值		0.012	0.008

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表 3 2组老年全麻膝关节置换术患者围手术期体温比较(x±s, ℃)

Table 3. Comparison of perioperative body temperature in two groups of elderly patients undergoing knee arthroplasty under general anesthesia(x±s, ℃)

组别	例数	T0	T1	T2	T3	T4	T5	T6
对照组	50	36.83±0.21	37.21±0.26	36.74±0.32	36.35±0.33	36.20±0.32	36.10±0.31	35.87±0.30
观察组	50	36.77±0.30	37.27±0.37	36.82±0.23	36.52±0.24	36.36±0.25	36.27±0.27	36.17±0.28
F值		1.159	0.938	1.435	2.946	2.786	2.924	5.169
P值		0.250	0.351	0.155	0.004	0.006	0.004	< 0.001

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表 4 2组老年全麻膝关节置换术患者手术前后应激反应指标比较(x±s)

Table 4. Comparison of stress response indicators before and after surgery in two groups of elderly patients undergoing knee arthroplasty under general anesthesia(x±s)

组别	例数	肾上腺皮质激素(pg/mL)		促肾上腺皮质激素释放激素(ng/mL)
组别	例数	术前	术后	术前	术后
对照组	50	28.24±4.38	51.38±10.37^b	17.74±3.44	28.15±6.36^b
观察组	50	27.27±4.46	46.80±8.93^b	18.77±3.49	24.59±5.13^b
统计量		1.097^a	7.278^c	1.486^a	5.315^c
P值		0.275	0.008	0.140	0.023
注：^a为t值，^c为F值。与同组术前比较，^bP < 0.05。

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表 5 2组老年全麻膝关节置换术患者凝血功能指标比较(x±s)

Table 5. Comparison of coagulation function indicators in two groups of elderly patients undergoing knee arthroplasty under general anesthesia(x±s)

组别	例数	部分活化凝血活酶时间(s)		凝血酶原时间(s)		血浆凝血酶时间(s)		纤维蛋白原(g/L)
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
对照组	50	28.27±3.54	27.57±3.22^b	11.88±1.19	10.60±1.01^b	17.22±1.55	16.70±1.11^b	4.31±0.29	4.70±0.45^b
观察组	50	29.65±3.52	29.28±3.61	11.51±1.24	11.40±1.22	17.08±1.51	17.52±1.54	4.33±0.31	4.27±0.30
统计量		1.955^a	12.641^c	1.522^a	5.273^c	0.457^a	12.606^c	0.333^a	19.141^c
P值		0.054	0.001	0.131	0.041	0.648	0.001	0.740	< 0.001
注：^a为t值，^c为F值。与同组术前比较，^bP < 0.05。

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参考文献(22)

[1]	国家麻醉专业质量控制中心. 围术期患者低体温防治专家共识(2023版)[J]. 协和医学杂志, 2023, 14(4): 734-743. National Quality Control Center of Anesthesia Specialty. 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 734-743.
[2]	UKRANI R D, ARIF A, SADRUDDIN A, et al. Intraoperative hypothermia in patients undergoing total knee arthroplasty: a cross-sectional study from a developing country[J]. BMC Musculoskelet Disord, 2021, 22(1): 504. DOI: 10.1186/s12891-021-04390-7.
[3]	JU J W, NAM K, SOHN J Y, et al. Association between intraoperative body temperature and postoperative delirium: a retrospective observational study[J]. J Clin Anesth, 2023, 87: 111107. DOI: 10.1016/j.jclinane.2023.111107.
[4]	ZHAO W, HU Y, WANG X. Effect of body temperature protection on intraoperative bleeding in elderly patients undergoing arthroplasty: a meta-analysis[J]. Altern Ther Health Med, 2024, 30(8): 269-275.
[5]	YOO J H, OK S Y, KIM S H, et al. Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: comparison with passive warming, a randomized controlled trial[J]. Medicine(Baltimore), 2021, 100(12): e25235. DOI: 10.1097/MD.0000000000025235.
[6]	SÜMER I, UYSAL H, YEŞILTAŞ S, et al. The effect of intraoperative body temperature on postoperative nausea and vomiting in pediatric patients[J]. J Perianesth Nurs, 2021, 36(6): 706-710.
[7]	朱炎, 顾甜甜, 王钦钦. 手术室保温护理对人工膝关节置换术患者的影响[J]. 齐鲁护理杂志, 2021, 27(22): 126-128. ZHU Y, GU T T, WANG Q Q. The influence of operating room insulation care on patients undergoing artificial knee joint replacement[J]. Journal of Qilu Nursing, 2021, 27(22): 126-128.
[8]	杨霞, 李国宏, 崔颖, 等. 全膝关节置换术患者低体温预防的清单式管理[J]. 护理学杂志, 2022, 37(19): 42-44, 57. YANG X, LI G H, CUI Y, et al. Prevention of intraoperative hypothermia by checklist for patients receiving total knee arthroplasty[J]. Journal of Nursing Science, 2022, 37(19): 42-44, 57.
[9]	陈美华, 李妍, 赵翠平, 等. 护理安全管理与风险预警控制体系对老年患者不良事件的预防效果分析[J]. 护理实践与研究, 2023, 20(9): 1410-1414. CHEN M H, LI Y, ZHAO C P, et al. Prevention effect analysis of nursing safety management and risk early warning control system on adverse events in elderly patients[J]. Nursing Practice and Research, 2023, 20(9): 1410-1414.
[10]	AN Y, TIAN Z R, LI F, et al. Risk prediction using the national early warning score and the worthing physiological scoring system in patients who were transported to the intensive care unit from the emergency department: a cohort study[J]. Intensive Crit Care Nurs, 2021, 64: 103015. DOI: 10.1016/j.iccn.2021.103015.
[11]	GILLESPIE K H, CHIBUK A, DOERING J, et al. Maternity nurses' responses to maternal early warning criteria[J]. MCN Am J Matern Child Nurs, 2021, 46(1): 36-42. doi: 10.1097/NMC.0000000000000683
[12]	YI J, ZHAN L, LEI Y, et al. Establishment and validation of a prediction equation to estimate risk of intraoperative hypothermia in patients receiving general anesthesia[J]. Sci Rep, 2017, 7(1): 13927. DOI: 10.1038/s41598-017-12997-x.
[13]	YUE X, ZHOU H J, TIAN F L, et al. Clinical impact of active inflatable insulation in older with undergoing knee arthroplasty[J]. Altern Ther Health Med, 2024, 30(9): 460-465.
[14]	LAURONEN S L, KALLIOVALKAMA J, AHO A, et al. Self-warming blanket versus forced-air warming blanket during total knee arthroplasty under spinal anaesthesia: a randomised non-inferiority trial[J]. Acta Anaesthesiol Scand, 2023, 67(8): 1102-1109. doi: 10.1111/aas.14283
[15]	LI T, CHEN L, SHI Y, et al. Construction of a risk prediction model for intraoperative hypothermia in patients undergoing lower extremity joint replacement[J]. J Perianesth Nurs, 2025, 40(1): 45-49. doi: 10.1016/j.jopan.2024.03.001
[16]	STOBBE A Y, MERTENS M J, NOLTE P A, et al. A warm air blanket is superior to a heated mattress in preventing perioperative hypothermia in orthopedic arthroplasties, a time-series analyses[J]. J Arthroplasty, 2024, 39(2): 326-331. e2. doi: 10.1016/j.arth.2023.08.039
[17]	DAI Z, ZHANG Y, YI J, et al. Validation of a prediction model for intraoperative hypothermia in patients receiving general anesthesia[J]. Int J Clin Pract, 2022, 2022: 6806225. DOI: 10.1155/2022/6806225.
[18]	ZHUO Q, XU J B, ZHANG J, et al. Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials[J]. BMC Pregnancy Childbirth, 2022, 22(1): 720. DOI: 10.1186/s12884-022-05054-7.
[19]	PALANISAMY S, RUDINGWA P, PANNEERSELVAM S, et al. Effect of low dose phenylephrine infusion on shivering and hypothermia in patients undergoing cesarean section under spinal anesthesia: a randomized clinical trial[J]. Int J Obstet Anesth, 2022, 50: 103542. DOI: 10.1016/j.ijoa.2022.103542.
[20]	TABH J, HARTJES M, BURNESS G. Endotherms trade body temperature regulation for the stress response[J]. Proc Biol Sci, 2023, 290(2010): 20231251. DOI: 10.1098/rspb.2023.1251.
[21]	HUI S, ZHANG Q, LANG J, et al. Temperature effect on coagulation function in mild hypothermic patients undergoing thoracic surgeries: thromboelastography (TEG) versus standard tests[J]. Perioper Med(Lond), 2024, 13(1): 55. DOI: 10.1186/s13741-024-00405-8.
[22]	周胤婵, 徐小娟, 刘卉蓉, 等. 失效模式与效应分析在全麻下截石位并发症风险防范中的应用[J]. 中华全科医学, 2024, 22(7): 1256-1259. doi: 10.16766/j.cnki.issn.1674-4152.003611 ZHOU Y C, XU X J, LIU H R, et al. Application of failure mode and effect analysis in risk prevention of complications at lithotomy site under general anesthesia[J]. Chinese Journal of General Practice, 2024, 22(7): 1256-1259. doi: 10.16766/j.cnki.issn.1674-4152.003611