术中低体温对老年腹股沟疝修补术后并发症的影响分析

Analysis of the impact of intraoperative hypothermia on postoperative complications after inguinal hernia repair in elderly patients

摘要:

背景与目的 老年腹股沟疝患者因生理机能衰退和体温调节能力减弱，术中易发生低体温，增加术后感染、认知功能障碍及血清肿等并发症发生风险。本研究旨在探讨术中体温水平与老年腹股沟疝术后并发症的关系，并评估其预测价值。方法 回顾性分析2018年4月—2024年10月在西南医科大学附属医院接受腹股沟疝修补术的358例老年患者的临床资料。低体温被定义为中心温度<36.0 ℃，根据术中体温水平将患者分为低体温组（20例）和正常体温组（338例）。比较两组患者的围手术期指标及术后并发症发生情况，采用多因素Logistic回归分析术后并发症发生的独立危险因素，并通过受试者工作特征（ROC）曲线评估术中体温的预测效能。结果 与正常体温组比较，低体温组患者的手术时间延长，术后白细胞（WBC）及中性粒细胞/淋巴细胞比值（NLR）明显升高，术后并发症发生率显著增加（25.0% vs. 3.8%，P<0.001）。多因素分析显示，年龄、营养风险评分、术中出血量、术后WBC、术后NLR及术中低体温均为术后并发症发生的独立危险因素。ROC曲线结果表明，术中体温预测术后并发症的曲线下面积为0.717，截断值为36.42 ℃，敏感度70.0%，特异度89.5%。结论 老年腹股沟疝患者术中低体温可显著增加术后并发症发生风险，且体温水平具有较好的预后预测价值。维持术中体温不低于36.4 ℃有助于降低并发症发生率、改善围术期结局。

Abstract:

Background and Aims Elderly patients with inguinal hernia are prone to intraoperative hypothermia due to diminished thermoregulatory capacity, which may increase the risk of postoperative complications such as infection, seroma, and cognitive dysfunction. This study aimed to investigate the relationship between intraoperative body temperature and postoperative complications in elderly patients undergoing inguinal hernia repair and to evaluate its predictive value.Methods Clinical data of 358 elderly patients who underwent tension-free inguinal hernia repair at the Affiliated Hospital of Southwest Medical University from April 2018 to October 2024 were retrospectively analyzed. Patients were divided into a hypothermia group (<36.0 ℃) and a normothermia group (≥36.0 ℃) according to intraoperative temperature levels. Perioperative parameters and postoperative complications were compared between the two groups. Independent risk factors for complications were identified using multivariate logistic regression, and the predictive performance of intraoperative temperature was evaluated by receiver operating characteristic (ROC) curve analysis.Results Compared with the normothermia group, patients with intraoperative hypothermia had significantly longer operative time, higher postoperative white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR), and an increased incidence of complications (25.0% vs. 3.8%, P<0.001). Multivariate analysis identified age, NRS 2002 score, intraoperative blood loss, postoperative WBC, postoperative NLR, and intraoperative hypothermia as independent risk factors for postoperative complications. ROC analysis showed that intraoperative temperature had a good predictive value for complications (AUC=0.717, optimal cutoff=36.42 ℃, sensitivity=70.0%, specificity=89.5%).Conclusion Intraoperative hypothermia significantly increases postoperative complication risk in elderly patients undergoing inguinal hernia repair. Maintaining intraoperative temperature above 36.4 ℃may reduce the incidence of complications and improve perioperative outcomes.