Zhongguo linchuang yanjiu (Feb 2025)
Analysis of intraoperative temperature changes and postoperative related indexes in patients undergoing thoracoscopic surgery and thoracotomy
Abstract
Objective：To observe and analyze the characteristics of temperature changes at different time points and the changes of postoperative indexes in adult thoracotomy and thoracoscopic surgery. Methods：A retrospective analysis was used to select 202 patients with elective thoracic surgery admilted in Beijing Chest Hospital from January 1st, 2020 to December 31st, 2023, and they were divided into the thoracoscopic group (102 cases) and the thoracotomy group (100 cases) according to the surgical Methods：A retrospective analysis was used to select 202 patients with elective thoracic surgery admilted in Beijing Chest Hospital from January 1st, 2020 to December 31st, 2023, and they were divided into the thoracoscopic group (102 cases) and the thoracotomy group (100 cases) according to the surgical methods. The core body temperature was measured after admission. The nasopharyngeal temperature was measured at entry (T0, induction of anesthesia (T1), thoracic entrance (T2, 30 min after surgery (T3, 60 min after surgery (T4, 90 min after surgery(T5, 120 min after surgery(T6, and thoracic closure(T7 of the patient. Changes of body temperature 3 days after operation was measured. Levels of C-reactive protein (CRP), white blood cell count and neutrophil percentage before and 1 day after surgery were measured. Results：The incidence of hypothermia in the thoracotomy group was 79.00% (79/100), and the lowest body temperature was 33.9 ℃. Logistic regression analysis showed that total fluid intake> 2 000 mL (OR=24.441, 95%CI:2.936-203.481, P=0.003) and low body temperature (OR=0.001,95%CI:0.001-0.071, P=0.002) were independent risk factors for intraoperative hypothermia in the thoracotomy group. The incidence of hypothermia in the thoracoscopic group was 60.78% (62/102), and the lowest body temperature was 34.2 ℃. Logistic regression analysis showed that age＞60 years old (OR=5.146,95%CI:1.621-16.340, P=0.005) and low internal body temperature (OR= 0.003,95%CI:0.001-0.044, P=0.001) were independent risk factors for intraoperative hypothermia in thoracoscopic patients. Anesthesia time, operation time and total infusion volume in thoracotomy group were higher than those in thoracoscopic group (P＜0.05). The level of CRP and white blood cell count were increased 1 day after thoracotomy group (P＜0.05). There was the time effect (F=198.725, P＜0.01) and interaction effect (F=4.166, P=0.030) of intraoperative body temperature. The time effect of postoperative body temperature (F=9.090, P＜0.01) and the interaction effect (F=11.688, P＜0.01) were statistically significant. Conclusion： A total fluid intake＞2 000 mL and a lower body temperature upon admission are independent risk factors for intraoperative hypothermia in patients undergoing open chest surgery. Age＞60 years and a lower body temperature upon admission are independent risk factors for intraoperative hypothermia in patients undergoing thoracoscopic surgery. Compared to thoracoscopic surgery, open chest surgery is associated with a greater degree of perioperative temperature drop and more significant postoperative temperature fluctuations.
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