非体外循环冠状动脉搭桥术后体温与全因死亡率关系的回顾性观察

背景与目的

在接受非体外循环冠状动脉搭桥术（OPCAB）的患者中，意外的围手术期低温是常见的。我们研究了术后早期体温与OPCAB患者全因死亡率的关系。

方法

我们回顾了1714例接受OPCAB治疗的患者的电子病历（随访时间中位数，47个月）。根据术后重症监护室入院时的体温，将患者分为4组（中到重度低温，<35.5℃；亚低温，35.5℃-36.5℃；常温，36.5℃-37.5℃；高温，<37.5℃）。Cox比例危险模型被用来评估体温与全因死亡率之间的关系。根据术后测得的体温将患者分为4类，评估术后早期体温变化与全因死亡率的关系。术后前3天的重症监护病房入院率和平均体温。

结果  

与常温组相比，中重度低温组的全因死亡率调整危险比为2.030（95%可信区间，1.407-2.930），亚低温组为1.445（95%可信区间，1.113-1.874）。与未恢复正常体温的患者相比，在术后重症监护室入院时体温过低但随后达到正常体温的患者，其全因死亡率的风险更低（调整后的危险比为0.631；95%可信区间为0.453-0.878），尽管他们仍然比那些持续常温的人有更高的全因死亡率（调整后的危险比，1.435；95%可信区间，1.090-1.890）。

结论

即使是术后早期轻度低温也与OPCAB后的全因死亡率相关。术后恢复正常体温的患者与未恢复正常体温的患者相比，其全因死亡率较低。

原始文献摘要

Karam Nam, Woo Young Jo, Seok Min Kwon，et al.Association Between Postoperative Body Temperature and All-Cause Mortality After Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Observational Study.Anesth Analg 2020;130:1381–8.

BACKGROUND: Inadvertent perioperative hypothermia is common in patients undergoing offpump coronary artery bypass grafting (OPCAB). We investigated the association between early postoperative body temperature and all-cause mortality in patients undergoing OPCAB.

METHODS: We reviewed the electronic medical records of 1714 patients who underwent OPCAB (median duration of follow-up, 47 months). Patients were divided into 4 groups based on body temperature at the time of intensive care unit admission after surgery (moderate-to-severe hypothermia, <35.5°C; mild hypothermia, 35.5°C–36.5°C; normothermia, 36.5°C–37.5°C; and hyperthermia, ≥37.5°C). Cox proportional hazards models were used to assess the association between body temperature and all-cause mortality. The association between early postoperative changes in body temperature and all-cause mortality was also assessed by dividing

the patients into 4 categories according to the body temperature measured at postoperative intensive care unit admission and the average body temperature during the first 3 postoperative days.

RESULTS: Compared to the normothermia group, the adjusted hazard ratios of all-cause mortality were 2.030 (95% confidence interval, 1.407–2.930) in the moderate-to-severe hypothermia group and 1.445 (95% confidence interval, 1.113–1.874) in the mild hypothermia group. Patients who were hypothermic at postoperative intensive care unit admission but attained normothermia thereafter were at a lower risk of all-cause mortality compared to patients who did

not regain normothermia (adjusted hazard ratio, 0.631; 95% confidence interval, 0.453–0.878), while they were still at a higher risk of all-cause mortality than those who were consistently normothermic (adjusted hazard ratio, 1.435; 95% confidence interval, 1.090–1.890).

CONCLUSIONS: Even mild early postoperative hypothermia was associated with all-cause mortality after OPCAB. Patients who regained normothermia postoperatively were at lower risk of all-cause mortality compared to those who did not.