目的:分析机器人辅助根治性膀胱切除术(RARC)患者采取术中体温管理后围术期低体温发生情况及其 影响因素。方法:选取 2018 年 3 月—2020 年 8 月西安市第三医院收治的 39 例行常规术中护理的 RARC 患者,将 其纳入对照组,另选取 2020 年 9 月—2023 年 3 月西安市第三医院收治的 39 例行术中保温护理的 RARC 患者, 将其纳入观察组。比较两组患者不同时点体温水平。结果:两组患者术中 1 h、3 h、5 h 体温低于术前,术中 5 h 体温高于术中 3 h,观察组术中 1 h、3 h、5 h 体温均高于对照组(P<0.05);观察组低体温发生率低于对照组 (P<0.05)。BMI < 24 kg/m2 、护理方式为常规术中护理、腹腔冲洗液量 >500 mL、术中补液量 >1500 mL 及手术时 间、气腹时间和麻醉时间长的患者低体温发生率高于 BMI ≥ 24 kg/m2 、护理方式为术中保温护理、腹腔冲洗液量 ≤ 500 mL、术中补液量≤ 1500 mL 及手术、气腹、麻醉时间短的患者(P<0.05)。二元 Logistic 回归分析结果显 示,手术时间和气腹时间长、腹腔冲洗液量 >500 mL、术中补液量 >1500 mL 是 RARC 患者围术期低体温发生的危 险因素(OR>1,P<0.05),采取术中体温管理是 RARC 患者围术期低体温发生的保护因素(OR<1,P<0.05)。 结论:术中体温管理能够有效稳定 RARC 患者术中体温,降低低体温发生率,且手术时间、气腹时间、腹腔冲洗液量、 术中补液量及护理方式是 RARC 患者围术期低体温发生的影响因素。
Objective: To analyze the incidence of perioperative hypothermia and its influencing factors in patients undergoing robot-assisted radical cystectomy (RARC) after intraoperative temperature management. Methods: 78 RARC patients in the Third Hospital of Xi’an from March 2018 to March 2023 were selected and divided into the control group (March 2018 to August 2020, routine intraoperative nursing, n=39) and the observation group (September 2020 to March 2023, intraoperative heat preservation nursing, n=39). Body temperatures of patients at different time points was compared between the two groups. Results: Body temperatures at intraoperative 1 h, 3 h and 5 h were lower than that before surgery, and the temperatures at intraoperative 5 h were higher than that at 3 h during surgery. Compared to the control group, the observation group demonstrated a lower incidence of hypothermia (P<0.05) and a higher temperature at 1 h, 3 h, and 5 h during surgery (P<0.05). The incidence of hypothermia was higher in patients with body mass index <24 kg/m2 , routine intraoperative nursing, abdominal lavage volume >500 mL, intraoperative rehydration volume >1500 mL, longer operative time, pneumoperitoneum time and anesthesia time than patients with body mass index≥24 kg/m2 , intraoperative warming nursing, abdominal lavage volume ≤500 mL, intraoperative rehydration volume ≤1500 mL, shorter operative time, pneumoperitoneum time and anesthesia time (P<0.05). Logistic regression results showed that long operative and pneumoperitoneum time, abdominal lavage volume >500 mL, and intraoperative rehydration volume >1500 mL were risk factors for perioperative hypothermia (OR>1, P<0.05), and intraoperative body temperature management was a protective factor in RARC patients (OR<1, P<0.05). Conclusion: Intraoperative temperature management can effectively stabilize the intraoperative body temperature and reduce the incidence of hypothermia. The operative time, pneumoperitoneum time, peritoneal lavage volume, intraoperative rehydration volume, and nursing methods are the influencing factors of perioperative hypothermia in RARC patients.
基金项目:陕西省重点研发计划项目(2017ZDXM-SF-045)
Foundation Item: Key R&D Plan Project of Shaanxi Province (2017ZDXM-SF-045)
通讯作者:王婷婷,Email:13892170870@139.com
Corresponding Author: WANG Tingting, Email: 13892170870@139.com
引用格式:杨芳,蔺洁璐,王黎萍,等 . 机器人辅助根治性膀胱切除术患者采取术中体温管理后围术期低体温发生情况及其影响 因素 [J]. 机器人外科学杂志(中英文),2025,6(1):128-133.
Citation: YANG F, LIN J L, WANG L P, et al. Incidence of perioperative hypothermia and its influencing factors in patients undergoing robot-assisted radical cystectomy after intraoperative temperature management [J]. Chinese Journal of Robotic Surgery, 2025, 6(1): 128-133.
[1] Reitblat C, Bellmunt J, Gershman B. Management of clinically regional node-positive urothelial carcinoma of the Bladder[J].Curr Oncol Rep, 2021, 23(2): 24.
[2] Suarez-Ibarrola R, Hein S, Reis G, et al. Current and future applications of machine and deep learning in urology: a review of the literature on urolithiasis, renal cell carcinoma, and bladder and prostate cancer[J].World J Urol, 2020, 38(10): 2329-2347.
[3] Tuderti G, Mastroianni R, Brassetti A, et al. Robot-assisted radical cystectomy with intracorporeal neobladder: impact of learning curve and long-term assessment of functional outcomes[J].Minerva Urol Nephrol, 2021, 73(6): 754-762.
[4] Wijburg C J, Michels C T J, Hannink G, et al. Robot-assisted radical cystectomy versus open radical cystectomy in bladder cancer patients: a multicentre comparative effectiveness study[J].Eur Urol, 2021, 79(5): 609-618.
[5] CHEN H Y, SU L J, WU H Z, et al. Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: a prospective cohort study[J].PLoS One, 2021, 16(9): e0257816.
[6] ZHANG J X, DEANG L Q, WANG X M, et al. Effect of forced-air warming blanket on perioperative hypothermia in elderly patients undergoing laparoscopic radical resection of colorectal cancer[J].Ther Hypothermia Temp Manag, 2022, 12(2): 68-73.
[7] Apfelbaum J L, Hagberg C A, Connis R T, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway[J].Anesthesiology, 2022, 136(1): 31-81.
[8] Rouprêt M, Babjuk M, Burger M, et al. European association of urology guidelines on upper urinary tract urothelial carcinoma: 2020 update[J].Eur Urol, 2021, 79(1): 62-79.
[9] 陈孝平 , 汪建平 , 赵继宗 . 外科学 ( 第九版 )[M]. 北京 : 人民卫 生出版社 , 2018: 567.
[10] 马正良 , 易杰 . 围手术期患者低体温防治专家共识 (2017)[J]. 协 和医学杂志 , 2017, 8(6): 352-358.
[11] 李梅春 , 纪忠 , 赵云 , 等 . 急诊行急性肠梗阻手术术中低体温危 险因素分析及预测模型建立 [J]. 蚌埠医学院学报 , 2024, 49(5): 659-662.
[12] Alushi B, Ndrepepa G, Lauten A, et al. Hypothermia in patients with acute myocardial infarction: a meta-analysis of randomized trials[J]. Clin Res Cardiol, 2021, 110(1): 84-92.
[13] ZHANG B Y, GU Q, CHEN X C, et al. Temperature variability does not attenuate the beneficial effects of therapeutic hypothermia on cellular apoptosis and endoplasmic reticulum stress in the cerebral cortex of a swine cardiac arrest model[J].Neurocrit Care, 2021, 34(3): 769-780.
[14] Wittenborn J, Mathei D, van Waesberghe J, et al. The effect of warm and humidified gas insufflation in gynecological laparoscopy on maintenance of body temperature: a prospective randomized controlled multi-arm trial[J].Arch Gynecol Obstet, 2022, 306(3): 753-767.
[15] 李丽 , 颜艳 , 房馨 , 等 . 腹腔镜手术患者术中低体温风险预测模 型的构建及验证 [J]. 中华护理杂志 , 2022, 57(4): 463-468.
[16] Koh W, Chakravarthy M, Simon E, et al. Perioperative temperature management: a survey of 6 Asia-Pacific countries[J].BMC Anesthesiol, 2021, 21(1): 205.
[17] 穆星宇 , 佟玥丽 , 普鹰 , 等 . 经尿道前列腺铥激光切除术患者围 术期低体温危险因素分析 [J]. 现代泌尿外科杂志 , 2023, 28(12): 1060-1064.
[18] 郁帆 , 王雪 , 马森 , 等 . 术后轻度低体温患者组合保暖与充气式 加温仪复温效果比较 [J]. 护理学杂志 , 2023, 38(15): 48-50.
[19] 苏玉琢 , 张颖 . 肝移植围术期低体温影响因素及预防措施的研 究进展 [J]. 中日友好医院学报 , 2023, 37(3): 171-173.
[20] 国家卫生和计划生育委员会 . 医院洁净手术部建筑技术规范[S]. 北京 : 中国建筑工业出版社 , 2013: 24-29.
[21] 赵兰红 , 杨丽 , 王敏 , 等 . 胃肠癌根治术患者术中低体温预测模 型的构建与验证 [J]. 中国临床研究 , 2023, 36(8): 1276-1280.
[22] 方丹 , 施静婧 . 普外科术中低体温发生情况 Logistics 回归分析 及预测模型构建 [J]. 新疆医科大学学报 , 2024, 47(1): 98-102.
[23] Groene P, Gündogar U, Hofmann-Kiefer K, et al. Influence of insufflated carbon dioxide on abdominal temperature compared to oesophageal temperature during laparoscopic surgery[J].Surg Endosc, 2021, 35(12): 6892-6896.
[24] Miyazaki R, Hoka S, Yamaura K. Visceral fat, but not subcutaneous fat, is associated with lower core temperature during laparoscopic surgery[J].PLoS One, 2019, 14(6): e0218281.
[25] Reeves N, White J, Bird S, et al. Warmed and humidified insufflation to prevent perioperative hypothermia and improve the quality of recovery in elective laparoscopic colorectal resection patients: a feasibility study for a triple-blind randomized controlled trial[J]. Colorectal Dis, 2021, 23(12): 3262-3271.
[26] Pokharel K, Subedi A, Tripathi M, et al. Effect of amino acid infusion during cesarean delivery on newborn temperature: a randomized controlled trial[J].BMC Pregnancy Childbirth, 2021, 21(1): 267.
[27] Ito Y, Kudo D, Kushimoto S. Association between low body temperature on admission and in-hospital mortality according to body mass index categories of patients with sepsis[J].Medicine (Baltimore), 2022, 101(44): e31657.
[28] 方敏 , 高兴莲 , 柯稳 , 等 . 腹部消化系统手术患者术中低体温风 险预测模型的构建与验证 [J]. 护理学报 , 2023, 30(20): 58-63.
[29] 柯稳 , 高兴莲 , 余文静 , 等 . 基于三维质量结构模型构建围手术 期低体温预防护理质量指标体系 [J]. 护理学报 , 2024, 31(1): 1-6.
[30] 孙亮 , 高倩 , 王广 , 等 . 麻醉后恢复室期间全身麻醉患者发生低 体温的影响因素 [J]. 中华医学杂志 , 2021, 101(1): 52-56.