关键词:

结直肠癌, 术中低体温, 危险因素, 预防性护理策略

Abstract:

Objective　To analyze the occurrence status and influencing factors of intraoperative hypothermia in patients undergoing laparoscopic radical resection of colorectal cancer (LRRCC), and to propose preventive nursing strategies. Methods　A total of 220 patients with colorectal cancer who underwent LRRCC in the operating room of Tongji Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology, from March 2021 to December 2023 were selected as the study subjects, including 123 males and 97 females. Patients were divided into an occurrence group (88 cases) and a non-occurrence group (132 cases) based on the occurrence of intraoperative hypothermia (core body temperature <36 ℃). Clinical data were collected for all patients, including age, gender, body mass index, diabetes, hypertension, American Society of Anesthesiologists (ASA) classification, preoperative heart rate, preoperative body temperature, preoperative albumin levels, operating room temperature, operating room humidity, anesthesia-to-incision time, surgery duration, intraoperative irrigation volume, intraoperative blood loss, presence of adverse nursing procedures, intraoperative fluid administration volume, preoperative Mini-Nutrition Assessment Screening Form (MNA-SF) nutritional score, presence of CO₂ insufflation warming and humidification, and presence of composite warming. Univariate analysis was performed using χ² tests, and multivariate logistic regression analysis was used to identify risk factors for intraoperative hypothermia in LRRCC patients. Results　This study involved 220 patients with LRRCC. During the operation, 88 cases experienced hypothermia, with an incidence rate of 40.00%. Poor control of   diabetes in the occurrence group, preoperative heart rate≤70 beats/min, anesthesia-delivery time>30 min, operation duration>3 h, intraoperative fluid volume>1.6 L, intraoperative blood loss>150 ml, improper operation by the medical staff, intraoperative fluid infusion volume>1 000 ml,     preoperative MNA-SF nutritional score≤12 points, no CO₂ pneumoperitoneum heating or humidification, and no compound heat preservation were all more common in the occurrence group  than in the non-occurrence group (all P<0.05). The results of multivariate logistic regression   analysis showed that poor control of diabetes (OR=6.642), preoperative heart rate≤70 beats/min   (OR=2.865), anesthesia-delivery time>30 min (OR=1.207), operation duration>3 h (OR=2.344),  intraoperative fluid volume>1.6 L (OR=2.711), intraoperative blood loss>150 ml (OR=2.354), improper operation by the medical staff (OR=2.149), intraoperative fluid infusion volume>1 000 ml (OR=2.109), preoperative MNA-SF nutritional score≤12 points (OR=2.192), no CO₂   pneumoperitoneum heating or humidification (OR=2.804), and no compound heat preservation (OR=3.040) were all risk factors for intraoperative hypothermia in patients with LRRCC (all P<0.05). The results of the Omnibus test for the model showed χ²=139.399, P<0.05, indicating that the model as a whole is statistically significant. In terms of model fit, the log-likelihood ratio for the model was 156.726, indicating that the quantitative evaluation model had good fit; the Hosmer-Lemeshow test results were χ²=8.784, P>0.05, indicating that the qualitative evaluation model had good fit. Conclusion　Poor control of diabetes, preoperative heart rate≤70 beats/min, anesthesia-delivery time>30 min, operation duration>3 h, intraoperative fluid volume>1.6 L, intraoperative blood loss>150 ml, improper operation by the medical staff, intraoperative fluid infusion volume>1 000 ml, preoperative MNA-SF nutritional score≤12 points, no CO₂ pneumoperitoneum heating or humidification, and no compound heat preservation were all risk factors for intraoperative hypothermia in patients with LRRCC. Implementing preventive nursing strategies based on the above factors can help reduce the risk of intraoperative hypothermia, and has guiding significance for future clinical practice and nursing management.

Key words:

Colorectal cancer, Intraoperative hypothermia, Risk factors, Preventive nursing strategies