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

摘要：

目的　分析腹腔镜结直肠癌根治术（LRRCC）患者术中低体温发生现状及影响因素，并提出预防性护理策略。方法　选取2021年3月至2023年12月在华中科技大学同济医学院附属同济医院手术室行LRRCC的220例结直肠癌患者作为研究对象，其中男123例，女97例。根据术中低体温（核心体温<36 ℃）发生情况，将患者分为发生组（88例）和未发生组（132例）。收集所有患者临床资料［年龄、性别、体重指数、糖尿病、高血压、美国麻醉学医师协会（ASA）分级、术前心率、术前体温、术前白蛋白水平、手术室温度、手术室湿度、麻醉-切皮时间、手术时间、术中冲洗量、术中出血量、医护人员是否存在不良操作、术中输液量、术前微型营养筛查表（MNA-SF）营养评分、是否存在CO₂气腹加温加湿、是否存在复合保温］。单因素分析采用χ²检验，并采用多因素logistic回归分析LRRCC患者术中发生低体温的危险因素。结果　本研究共220例LRRCC患者，术中发生低体温88例，发生率为40.00%。发生组糖尿病控制不良、术前心率≤70 次/min、麻醉-切皮时间>30 min、手术时间>3 h、术中冲洗量>1.6 L、术中出血量>150 ml、医护人员存在不良操作、术中输液量>1 000 ml、术前MNA-SF营养评分≤12分、未存在CO₂气腹加温加湿、未存在复合保温占比均高于未发生组（均P<0.05）。多因素logistic回归分析结果显示，糖尿病控制不良（OR=6.642）、术前心率≤70 次/min（OR=2.865）、麻醉-切皮时间>30 min（OR=1.207）、手术时间>3 h（OR=2.344）、术中冲洗量>1.6 L（OR=2.711）、术中出血量>150 ml（OR=2.354）、医护人员存在不良操作（OR=2.149）、术中输液量>1 000 ml（OR=2.109）、术前MNA-SF营养评分≤12分（OR=2.192）、未存在CO₂气腹加温加湿（OR=2.804）、未存在复合保温（OR=3.040）均是LRRCC患者术中发生低体温的危险因素（均P<0.05）。模型Omnibus检验结果显示，χ²=139.399，P<0.05，表明模型整体具有统计学意义。模型拟合优度方面，模型-2倍对数似然值=156.726，表明量化评价模型拟合优度效果较好；Hosmer-Lemeshow检验结果为χ²=8.784，P>0.05，表明质性评价模型拟合优度较好。结论　糖尿病控制不良、术前心率≤70 次/min、麻醉-切皮时间>30 min、手术时间>3 h、术中冲洗量>1.6 L、术中出血量>150 ml、医护人员存在不良操作、术中输液量>1 000 ml、术前MNA-SF营养评分≤12分、未存在CO₂气腹加温加湿、未存在复合保温均是LRRCC患者术中发生低体温的危险因素。针对以上因素实施预防性护理策略，有助于降低术中低体温风险，对今后的临床实践及护理管理具有指导意义。

关键词:

结直肠癌, 术中低体温, 危险因素, 预防性护理策略