Analysis in the influencing factor of intraoperative hypothermia during laparotomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIAO Anque ¹ ,  LI Ka ²

1. Operation Room, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. College of Nursing, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LI Ka, Email: lika127@126.com

Keywords：

intraoperative hypothermia; laparotomy; hepatectomy; gastrectomy; intraoperative bleeding volume; intraoperative infusion volume

DOI：

10.7507/1007-9424.201909007

Video：

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Objective To investigate the influencing factor of intraoperative hypothermia during laparotomy.Methods A total of 81 patients underwent laparotomy in our hospital from October 1, 2018 to January 1, 2019 were enrolled. The difference of preoperative baseline data and surgical data between the hypothermia and non-hypothermia groups was compared, and the influencing factor of intraoperative hypothermia during laparotomy was explored.Results Of the 81 patients, 32 patients occurred hypothermia during operation. There were no significant differences in gender, age, BMI, HGB, WBC count, PLT count, TB, AST, ALT, ALB, PT, operation time, postoperative hospital stay, and Clavien-Dindo grade between the hypothermia group and the non-hypothermia group (P>0.05), but there were significant differences in intraoperative infusion volume, intraoperative blood loss, and surgical mode (P<0.05). The intraoperative infusion volume and intraoperative blood loss in the hypothermia group were higher than those in the non-hypothermia operation group, and the proportion of hepatectomy was higher than that in the non-hypothermia group. The multivariate analysis show that the intraoperative blood loss, intraoperative infusion volume, and kind of operation were the risk factors for the hypothermia during laparotomy (P<0.05).Conclusions Intraoperative hypothermia is related to intraoperative bleeding volume, intraoperative fluid infusion volume, and the kind of operation. Therefore, for patients with less bleeding, the intraoperative hypothermia can be reduced by limiting the volume of intraoperative fluid infusion. For those patients with more intraoperative bleeding, warming fluid infusion may reduce the incidence of intraoperative hypothermia.

Citation： LIAO Anque, LI Ka. Analysis in the influencing factor of intraoperative hypothermia during laparotomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 163-167. doi: 10.7507/1007-9424.201909007 Copy

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2.	Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology, 1997, 87(6): 1318-1323.
3.	Karalapillai D, Story D, Hart GK, et al. Postoperative hypothermia and patient outcomes after major elective non-cardiac surgery. Anaesthesia, 2013, 68(6): 605-611.
4.	Pearce B, Mattheyse L, Ellard L, et al. Comparison of the WarmCloud and bair hugger warming devices for the prevention of intraoperative hypothermia in patients undergoing orthotopic liver transplantation: a randomized clinical trial. Transplant Direct, 2018, 4(4): e358.
5.	National Collaborating Centre for Nursing and Supportive Care (UK). The management of inadvertent perioperative hypothermia in adults. 2018-04. https://www.ncbi.nlm.nih.gov/pubmed/?term=21678626.
6.	De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology, 2002, 96(2): 467-484.
7.	蔡改革, 何龍, 張瑞珍, 等. 圍術期低體溫及其防治進展. 河南外科學雜志, 2018, 24(2): 159-162.
8.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
9.	Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med, 2009, 360(5): 491-499.
10.	Sink EL, Leunig M, Zaltz I, et al. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res, 2012, 470(8): 2220-2226.
11.	Karalapillai D, Story DA, Calzavacca P, et al. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5 050 patients. Anaesthesia, 2009, 64(9): 968-972.
12.	Sun Z, Honar H, Sessler DI, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology, 2015, 122(2): 276-285.
13.	Sessler DI. Mild perioperative hypothermia. N Engl J Med, 1997, 336(24): 1730-1737.
14.	劉玉, 李玲. 保溫護理對全身麻醉患者術中應激及術后蘇醒影響的臨床研究. 河北醫學, 2014, 20(7): 1200-1202, 1203.
15.	吳凡琦. 手術期間低體溫的護理研究. 中外醫學研究, 2010, 8(22): 123.
16.	Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
17.	Denu AZ, Semple P, Tawuye HY, et al. Perioperative hypothermia and predictors of intra-operative hypothermia among patients operated at Gondar University Hospital from March to April 2015. J Anesth Clin Res, 2015, 6(556): 2.
18.	馮騰塵. 圍術期低體溫防治研究進展. 中華實用診斷與治療雜志, 2016, 30(3): 218-221.
19.	Baucom RB, Phillips SE, Ehrenfeld JM, et al. Association of perioperative hypothermia during colectomy with surgical site infection. JAMA Surg, 2015, 150(6): 570-575.
20.	Menzel M, Grote R, Leuchtmann D, et al. Implementation of a thermal management concept to prevent perioperative hypothermia: results of a 6 month period in clinical practice. Anaesthesist, 2016, 65(6): 423-429.
21.	王地萍, 張紅芹. 術中低體溫的原因及預防. 吉林醫學, 2014, 35(20): 4583-4583.
22.	黃海媚. 綜合保溫措施在預防腹部手術患兒術中低體溫的應用. 右江醫學, 2011, 39(5): 588-589.
23.	Campbell G, Alderson P, Smith AF, et al. Warning of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev, 2015, (4): D9891.
24.	王家良. 臨床流行病學—臨床科研設計、測量與評價. 第 4 版, 上海: 上海科學出版社, 2014: 320-337.

1. 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. N Engl J Med, 1996, 334(19): 1209-1215.
2. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology, 1997, 87(6): 1318-1323.
3. Karalapillai D, Story D, Hart GK, et al. Postoperative hypothermia and patient outcomes after major elective non-cardiac surgery. Anaesthesia, 2013, 68(6): 605-611.
4. Pearce B, Mattheyse L, Ellard L, et al. Comparison of the WarmCloud and bair hugger warming devices for the prevention of intraoperative hypothermia in patients undergoing orthotopic liver transplantation: a randomized clinical trial. Transplant Direct, 2018, 4(4): e358.
5. National Collaborating Centre for Nursing and Supportive Care (UK). The management of inadvertent perioperative hypothermia in adults. 2018-04. https://www.ncbi.nlm.nih.gov/pubmed/?term=21678626.
6. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology, 2002, 96(2): 467-484.
7. 蔡改革, 何龍, 張瑞珍, 等. 圍術期低體溫及其防治進展. 河南外科學雜志, 2018, 24(2): 159-162.
8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
9. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med, 2009, 360(5): 491-499.
10. Sink EL, Leunig M, Zaltz I, et al. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res, 2012, 470(8): 2220-2226.
11. Karalapillai D, Story DA, Calzavacca P, et al. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5 050 patients. Anaesthesia, 2009, 64(9): 968-972.
12. Sun Z, Honar H, Sessler DI, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology, 2015, 122(2): 276-285.
13. Sessler DI. Mild perioperative hypothermia. N Engl J Med, 1997, 336(24): 1730-1737.
14. 劉玉, 李玲. 保溫護理對全身麻醉患者術中應激及術后蘇醒影響的臨床研究. 河北醫學, 2014, 20(7): 1200-1202, 1203.
15. 吳凡琦. 手術期間低體溫的護理研究. 中外醫學研究, 2010, 8(22): 123.
16. Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 2008, 108(1): 71-77.
17. Denu AZ, Semple P, Tawuye HY, et al. Perioperative hypothermia and predictors of intra-operative hypothermia among patients operated at Gondar University Hospital from March to April 2015. J Anesth Clin Res, 2015, 6(556): 2.
18. 馮騰塵. 圍術期低體溫防治研究進展. 中華實用診斷與治療雜志, 2016, 30(3): 218-221.
19. Baucom RB, Phillips SE, Ehrenfeld JM, et al. Association of perioperative hypothermia during colectomy with surgical site infection. JAMA Surg, 2015, 150(6): 570-575.
20. Menzel M, Grote R, Leuchtmann D, et al. Implementation of a thermal management concept to prevent perioperative hypothermia: results of a 6 month period in clinical practice. Anaesthesist, 2016, 65(6): 423-429.
21. 王地萍, 張紅芹. 術中低體溫的原因及預防. 吉林醫學, 2014, 35(20): 4583-4583.
22. 黃海媚. 綜合保溫措施在預防腹部手術患兒術中低體溫的應用. 右江醫學, 2011, 39(5): 588-589.
23. Campbell G, Alderson P, Smith AF, et al. Warning of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev, 2015, (4): D9891.
24. 王家良. 臨床流行病學—臨床科研設計、測量與評價. 第 4 版, 上海: 上海科學出版社, 2014: 320-337.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis in the influencing factor of intraoperative hypothermia during laparotomy

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