剖宫产期间产妇低体温的预测因素：前瞻性队列研究
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Predictive factors of maternal hypothermia during Cesarean delivery: a prospective cohort study
背景与目的
虽然围术期低体温可增加产妇发病率，但少有采取加温措施以维持剖宫产期间产妇正常体温。本前瞻性观察研究的目的是确定剖宫产期间产妇低体温的相关因素。
方 法
2014年11月至2015年10月期间，连续纳入择期或急诊剖宫产产妇。在产妇到达手术室时、切皮时和缝皮结束时使用红外鼓膜温度计测量产妇体温。产妇低体温定义为缝皮结束时的鼓膜温度＜36℃。进行单因素分析，然后进行多变量逻辑回归分析，以确定手术结束时产妇低体温的相关因素。
结 果
本研究纳入分析了359名产妇。低体温总发生率为23％（95％CI，18%〜27%）。根据多变量分析，肥胖、催产素应用增加和空气加温与产妇低体温的风险降低相关，而产妇到达手术室体温＜37.1℃、切皮时产妇温度＜36.6℃、输液量＞650 mL与产妇低体温明显相关。多变量分析的拟合优度和预测价值都较高。
结 论
剖宫产期间产妇低体温的几个预测因素得以确定，应考虑到这些因素以防止产妇体温过低。
原始文献摘要
Desgranges FP, Bapteste L, Riffard C, et al. Predictive factors of maternal hypothermia during Cesarean delivery: a prospective cohort study[J]. Can J Anaesth,2017. doi: 10.1007/s12630-017-0912-2. [Epub ahead of print]
PURPOSE: Although perioperative hypothermia may increase maternal morbidity, active warming is infrequently performed to maintain normothermia during Cesarean delivery (CD). The aim of this prospective observational study was to determine the factors associated with maternal hypothermia in this setting.
METHODS: Women scheduled for elective or emergency CD were consecutively included in this study from November 2014 to October 2015. Maternal temperature was measured using an infrared tympanic thermometer on the patient's arrival in the operating room, at skin incision, and at the end of skin suture. Maternal hypothermia was defined by tympanic temperature < 36°C at the end of skin suture. Univariate analysis was performed, followed by multivariate logistic regression analysis, in order to determine the factors associated with maternal hypothermia at the end of the surgery.
RESULTS: Three hundred fifty-nine women were included and analyzed during this study. The incidence of hypothermia was 23% (95% confidence interval, 18 to 27) among the total population included. According to multivariate analysis, obesity, oxytocin augmentation of labour, and use of active forced-air warming were associated with a decreased risk of maternal hypothermia, while maternal temperature < 37.1°C on arrival in the operating room, maternal temperature < 36.6°C at skin incision, and an infused volume of fluids > 650 mL were significantly associated with maternal hypothermia. Both goodness of fit and predictive value of multivariate analysis were high.
CONCLUSION: Several predictive factors for maternal hypothermia during CD were identified. These factors should be taken into account to help prevent maternal hypothermia during CD.
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