UNINTENTIONAL HYPOTHERMIA IS ASSOCIATED WITH POSTOPERATIVE MYOCARDIAL-ISCHEMIA
UNINTENTIONAL HYPOTHERMIA IS ASSOCIATED WITH POSTOPERATIVE MYOCARDIAL-ISCHEMIA
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DOI：
10.1097/00000542-199303000-00010
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发表时间：
1993-03-01
期刊：
影响因子：
8.8
通讯作者：
STEVENSON, RJ
中科院分区：
文献类型：
--
作者：
FRANK, SM;BEATTIE, C;STEVENSON, RJ
背景资料：低体温通常发生在手术期间，并且可能与术后复温期间代谢需求增加有关。虽然心脏并发症仍然是麻醉和手术后发病的主要原因，但围手术期意外低温与心肌缺血之间的关系尚未研究。100例接受下肢血管重建的患者在术后24 h内接受连续霍尔特监测。心肌缺血由心脏病专家确定，不知道临床变量。手术后患者到达重症监护室时的舌下温度用于将患者分为两组：低体温（温度< 35 ℃; n = 33）和正常体温（温度大于或等于35 ℃; n = 67）。意外低温和心肌缺血发生在术后第一天之间的关系进行了评估，通过单变量和多变量analysis.Results：一个更大的百分比的患者有心电图变化符合心肌缺血的低温组（36%，12 33）与常温组（13%，9 67，P= 0.008）相比。除患者年龄外，两组围手术期心脏病发病率的术前风险因素相似。低温组和常温组的平均年龄分别为70 +/- 2岁和62 +/- 1岁（P = 0.001）。 当使用亚组和多变量分析来校正年龄差异时，温度仍然是缺血的独立预测因子（比值比，1.82/摄氏度; 95%置信区间，1.09-3.02）。低温组术后心绞痛的发生率（18%，6/33）高于常温组（1.5%，1/67，P = 0.002）。低温组动脉血Pa（O2）< 80 mmHg的发生率（52%，17/33）高于常温组（30%，20/67），P <0.03。结论：下肢血管手术患者术后早期意外低温与心肌缺血、心绞痛及Pa（O2）< 80 mmHg有关。
Background: Hypothermia occurs commonly during surgery and can be associated with increased metabolic demands during rewarming in the postoperative period. Although cardiac complications remain the leading cause of morbidity after anesthesia and surgery, the relationship between unintentional hypothermia and myocardial ischemia during the perioperative period has not been studied.Methods. One hundred patients undergoing lower extremity vascular reconstruction received continuous Holter monitoring throughout the first 24 h postoperatively. Myocardial ischemia was determined by a cardiologist masked to clinical variables. The patient's sublingual temperature on arrival at the intensive care unit immediately after the surgical procedure was used to divide the patients into two groups: hypothermic (temperature, < 35-degrees-C; n = 33) and normothermic (temperature, greater-than-or-equal-to 35-degrees-C; n = 67). The relationship between unintentional hypothermia and myocardial ischemia occurring during the first postoperative day was evaluated by univariate and multivariate analyses.Results: A greater percentage of patients had electrocardiographic changes consistent with myocardial ischemia in the hypothermic group (36%, 12 of 33) compared with those in the normothermic group (13%, 9 of 67, P= 0.008). Preoperative risk factors for perioperative cardiac morbidity were similar between the two groups, except for patient age. The mean age was 70 +/- 2 yr and 62 +/- 1 yr in the hypothermic and normothermic groups, respectively (P = 0.001). When subgroup and multivariate analyses were used to adjust for differences in age, temperature remained an independent predictor of ischemia (odds ratio, 1.82 per degree Celsius; 95% confidence interval, 1.09-3.02). The incidence of postoperative angina was greater in the hypothermic group (18%, 6 of 33) than in the normothermic group (1.5%, 1 of 67, P = 0.002). The incidence of Pa(O2) < 80 mmHg in the arterial blood was greater in the hypothermic group (52%,17 of 33) than in the normothermic group (30%, 20 of 67, P 0.03).Conclusions: Unintentional hypothermia is associated with myocardial ischemia, angina, and Pa(O2) < 80 mmHg during the early postoperative period in patients undergoing lower extremity vascular surgery.