切换至 "中华医学电子期刊资源库"
高级检索
中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2024, Vol. 11 ›› Issue (01) : 47 -52. doi: 10.3877/cma.j.issn.2095-8765.2024.01.011

护理园地

术中体温水平对代谢综合征合并胃食管反流病行腹腔镜袖状胃切除联合胃底折叠术患者预后的影响
程晨1, 赵从1, 蒋媛2, 张丽1,†()   
  1. 1. 830011　乌鲁木齐，新疆维吾尔自治区人民医院中心手术室
    2. 830011　乌鲁木齐，新疆维吾尔自治区人民医院微创、疝与腹壁外科
  • 收稿日期:2023-11-29 出版日期:2024-02-15
  • 通信作者: 张丽
  • 基金资助:
    新疆维吾尔自治区人民医院院内项目(20210245)

Effect of intraoperative body temperature on the prognosis of patients with metabolic syndrome complicated with gastroesophageal reflux disease undergoing laparoscopic sleeve gastrectomy combined with fundoplication

Chen Cheng1, Cong Zhao1, Yuan Jiang2, Li Zhang1,†()   

  1. 1. Central Operating Room, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830011, China
    2. Department of Minimally Invasive, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830011, China
  • Received:2023-11-29 Published:2024-02-15
  • Corresponding author: Li Zhang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

程晨, 赵从, 蒋媛, 张丽. 术中体温水平对代谢综合征合并胃食管反流病行腹腔镜袖状胃切除联合胃底折叠术患者预后的影响[J]. 中华胃食管反流病电子杂志, 2024, 11(01): 47-52.

Chen Cheng, Cong Zhao, Yuan Jiang, Li Zhang. Effect of intraoperative body temperature on the prognosis of patients with metabolic syndrome complicated with gastroesophageal reflux disease undergoing laparoscopic sleeve gastrectomy combined with fundoplication[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2024, 11(01): 47-52.

目的

探讨术中体温水平对代谢综合征合并胃食管反流病(GERD)行腹腔镜袖状胃切除术联合胃底折叠手术患者预后的影响。

方法

回顾性分析2020年3月至2023年3月，新疆维吾尔自治区人民医院微创、疝与腹壁外科收治的188例诊断为代谢综合征合并GERD并且行腹腔镜袖状胃切除联合胃底折叠手术患者的临床资料。采用Logistic回归法进行多因素分析术中体温水平对预后的影响，并运用受试者工作特征(ROC)曲线分析术中体温水平对患者预后的预测价值。

结果

并发症组患者的术中体温水平低于非并发症组，差异有统计学意义(36.48 ℃±0.24 ℃比36.67 ℃±0.22 ℃; P=0.002)。Logistic回归分析发现术中低体温是术后并发症发生的危险因素(P<0.05)，并且术中体温水平预测患者预后的ROC曲线下面积>0.7。

结论

术中低体温是代谢综合征合并GERD行腹腔镜袖状胃切除联合胃底折叠手术后并发症发生的危险因素，术中体温水平对预后具有较高的预测价值。

关键词: 代谢综合征, 胃食管反流病, 腹腔镜袖状胃切除术, 胃底折叠, 体温水平, 预后
Objective

To investigate the effect of intraoperative body temperature on the prognosis of patients with metabolic syndrome complicated with gastroesophageal reflux disease(GERD) undergoing laparoscopic sleeve gastrectomy combined with fundoplication.

Methods

The clinical data of 188 patients diagnosed as metabolic syndrome complicated with GERD who underwent laparoscopic sleeve gastrectomy combined with fundoplication from March 2020 to March 2023 in Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. Logistic regression method was used to analyze the influence of intraoperative body temperature level on prognosis, and ROC curve was used to analyze the predictive value of intraoperative body temperature level on prognosis of patients.

Results

The intraoperative body temperature of patients with complications was lower than that of patients without complications(36.48 ℃ ± 0.24 ℃ vs 36.67 ℃ ± 0.22 ℃, P=0.002). Logistic regression analysis showed that intraoperative hypothermia was a risk factor for postoperative complications, and the AUC of intraoperative body temperature level in predicting the prognosis of patients was greater than 0.7.

Conclusion

Intraoperative hypothermia is a risk factor for complications after laparoscopic sleeve gastrectomy combined with fundoplication for metabolic syndrome complicated with GERD. Intraoperative hypothermia has high predictive value for prognosis.

Key words: Metabolic syndrome, Gastroesophageal reflux disease, Laparoscopic sleeve gastrectomy, Fundoplication, Body temperature level, Prognosis
表1 2组临床资料比较
临床资料 并发症组（15例） 非并发症组（173例） χ2/t值 P值
年龄(岁，) 36.73±10.68 35.64±8.78 0.454 0.650
性别[例(%)] 0.144 0.704
男性 7(46.7) 72(41.6)
女性 8(53.3) 101(58.4)
BMI(kg/m2，) 37.97±4.69 40.18±7.53 -1.118 0.265
合并症[例(%)] 3.957 0.047
是 6(40.0) 32(18.5)
否 9(60.0) 141(81.5)
吸烟史[例(%)] 0.621 0.431
是 7(46.7) 63（36.4）
否 8(53.3) 110（63.6）
酗酒史[例(%)] 4.373 0.037
是 5(33.3) 23（13.3）
否 10(66.7) 150（86.7）
ASA分级 5.203 0.023
I/II级 10(66.7) 152（87.9）
III/IV级 5(33.3) 21（12.1）
手术时间(min,) 170.80±8.08 163.41±11.87 2.361 0.019
出血量(ml,) 89.40±5.90 82.65±10.33 2.494 0.014
术中体温水平(℃,) 36.48±0.24 36.67±0.22 -3.182 0.002
表2 LSG手术预后危险因素的多因素Logistic回归分析
因素 β SE Wald χ2 P值 OR 95%CI
合并症 2.028 0.766 7.015 0.008 7.601 1.694~34.099
酗酒史 1.619 0.792 4.182 0.041 5.046 1.070~23.809
ASA分级 -1.659 0.729 5.170 0.023 0.190 0.046~0.795
手术时间 0.063 0.031 4.074 0.044 1.066 1.002~1.133
出血量 0.132 0.058 5.110 0.024 1.141 1.018~1.280
术中体温水平 -4.274 1.613 7.019 0.008 0.014 0.001~0.329
图1 腹腔镜袖状胃切除术术中体温水平预测术后预后的采用受试者工作特征曲线
1
Runkel N, Brydniak R. Surgical treatment of metabolic syndrome[J]. Visc Med, 2016, 32(5): 352-356.
2
Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations[J]. Obes Surg, 2017, 27(1): 2-21.
3
Nasser H, Munie S, Kindel TL, et al. Comparative analysis of robotic versus laparoscopic revisional bariatric surgery: perioperative outcomes from the MBSAQIP database[J]. Surg Obes Relat Dis, 2020, 16: 397-405.
4
刘洋, 李梦伊, 张松海, 等. 大华北减重与代谢手术临床资料数据库年度报告(2018)[J]. 中国实用外科杂志,2019,39(2):149-154.
5
Wozniewska P, Diemieszczyk I, Hady HR. Complications associated with laparoscopic sleeve gastrectomy - a review[J]. Gastroenterol Rev, 2021, 16(1): 5-9.
6
Fletcheer R, Deal R, Kubasiak J, et al. Predictors of increased length of hospital stay following laparoscopic sleeve gastrectomy from the national surgical quality improvement program[J]. J Gastrointest Surg, 2017, 22 (2): 274-278.
7
Nickel F, De La GarzaJr, Werthmann FS, et al. Predictors of risk and success of obesity surgery[J]. Obesity Facts, 2019, 12(4): 427-439.
8
Haskins In, Nowacki As, Khorgami Z, et al. Should recent smoking be a contraindication for sleeve gastrectomy?[J]. Surg Obes Relat Dis, 2017, 13 (7): 1130-1135.
9
王存川, 张鹏, 赵玉沛.腹腔镜袖状胃切除术操作指南(2018版)[J/OL].中华肥胖与代谢病电子杂志,2018,4(4):196-201.
10
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes[J]. N Engl J Med, 2017, 376(7): 641-651.
11
Peterli R, Wolnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus roux-y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized swiss multicenter bypass or sleeve study (SM-BOSS)[J]. Ann Surg, 2017, 265 (3): 466-473.
12
Gluszynska P, Diemieszczyk I, Szczerbinski L, et al. Risk factors for early and late complications after laparoscopic sleeve gastrectomy in one-year observation[J]. J Clin Med, 2022, 11 (2):436.
13
马钰栋, 周爱明, 顾德智, 等.腹腔镜袖状胃切除术后早期并发症的影响因素分析[J].中国普外基础与临床杂志,2023,30(5):582-586.
14
Lorente L, Ramon J, Vidal P, et al. Obesity surgery mortality risk score for the prediction of complications after laparoscopic bariatric surgery[J]. Cir Esp (Engl Ed), 2014, 92 (5): 316-323.
15
Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP study[J]. J Gastrointest Surg, 2011, 16(1): 35-44.
16
Guetta O, Vakhrushev A, Dukhno O, et al. New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients[J]. World J Diabetes, 2019, 10 (2): 78-86.
17
Allum Wh, Blazeby Jm, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer[J]. Gut, 2011, 60 (11): 1449-1472.
18
王青峰, 陆晶晶, 鲁生林, 等. 新辅助化疗后行腹腔镜胃癌根治术并发症有关影响因素及预后分析[J]. 临床外科杂志, 2023, 31(9): 860-863.
19
刘萍, 吴梦平, 徐渭, 等. 胃肠恶性肿瘤患者非计划再次手术风险因素分析[J]. 中国病案, 2021, 22(9): 55-59.
20
Blaszak AM, Jalilvand A, Hsueh WA. Adipocytes, innate immunity and obesity: a mini-review[J]. Front Immunol, 2021, 12: 650768.
21
Li S, Pang NN, Yan P, et al.Control of body temperature and immune function in patients undergoing open surgery for gastric cancer[J]. Bosn J Basic Med Sci, 2018, 18(3): 289-296.
22
肖瑶, 杨慧, 胡娟娟, 等．围手术期低体温预防及管理的循证实践[J].中华护理杂志,2019,54(9):1302-1307.
23
曹晖, 陈亚进, 顾小萍, 等.中国加速康复外科临床实践指南(2021版)[J].中国实用外科杂志,2021,41(9):961-992.
24
孔珊珊, 申海艳, 郑洪, 等.医护人员实施剖宫产术中体温管理影响因素的质性研究[J].护理学杂志,2020,35(23):31-34, 41.
25
李玉梅, 张宏晨, 陈晓东, 等.围术期低体温风险预测模型的研究进展[J].护理研究,2021,35(17):3107-3110.
26
王会, 张倩, 万一聪.初始室温控制对卵巢癌开腹手术患者术中体温变化的影响[J].护士进修杂志,2021,36(19):1772-1776.
27
Sun Y, Jia LL, Yu WL, et al. The changes of intraoperative body temperature in adult liver transplantation: a retrospective study[J]. Hepatobiliary Pancreat Dis Int,2018,17(6):496-501.
[1] 孙姚承, 汤建军, 张伟元, 刘传磊. 阳性淋巴结比和阳性淋巴结对数比对结直肠癌患者预后价值的研究[J]. 中华普通外科学文献(电子版), 2024, 18(03): 204-208.
[2] 孙建娜, 孔令军, 任崇禧, 穆坤, 王晓蕊. 266例首诊Ⅳ期乳腺癌手术患者预后分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 502-505.
[3] 袁庆港, 刘理想, 张亮, 周世振, 高波, 丁超, 管文贤. 尿素-肌酐比值（UCR）可预测结直肠癌患者术后的长期预后[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 506-509.
[4] 黄福, 王黔, 金相任, 唐云川. VEGFR2、miR-27a-5p在胃癌组织中的表达与临床病理参数及预后的关系研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 558-561.
[5] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[6] 蔡大明, 陆晓峰, 王行舟, 王萌, 刘颂, 夏雪峰, 沈晓菲, 杜峻峰, 管文贤. 三级淋巴结构在胃神经内分泌瘤中的预后价值及预后预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 401-405.
[7] 达热拜·热达提, 刘林, 赵为民, 孟涛, 雷程, 金博, 毕建军, 李新宇, 王海江. 中低位直肠癌新辅助放化疗后侧方淋巴结清扫术的临床观察[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 415-418.
[8] 李勇, 彭天明, 王倩倩, 陈育纯, 蒲小勇, 刘久敏. 基于失巢凋亡相关基因的膀胱癌预后模型构建及分析[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 331-339.
[9] 钱承博, 殷虎明, 邱峰, 侯建全, 黄玉华, 魏雪栋. 高龄患者行腹腔镜膀胱根治W形回肠新膀胱术的临床价值与风险评估[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 346-352.
[10] 张斌, 孙代宇, 胡昕, 韩菲, 李久明, 李功雨, 吴伟力, 冯宝富, 彭国辉. 评分系统预测不同经验手术者输尿管软镜术后结石清除率准确性的比较研究[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 353-360.
[11] 刘中文, 刘畅, 高洋, 刘东, 林世庆, 杨建华, 赵福义. 尿液microRNA-326与腹腔镜根治性膀胱切除术治疗膀胱癌患者预后的相关性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 386-391.
[12] 周慧宇, 吕定阳, 双卫兵. 联合系统性免疫炎症指数和预后营养指数预测腹腔镜肾切除术后肾癌患者的预后[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 225-231.
[13] 杨秀君, 崔梦莹, 刘水, 盛基尧, 张丹. 基于SEER数据库胰头部胰腺神经内分泌癌患者预后列线图构建与验证[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 520-525.
[14] 王小龙, 吴杰, 段姝伟, 王超卉, 潘娜, 白圆圆, 李航天, 蔡广研. 不同等级体力活动对慢性肾脏病患者预后的影响[J]. 中华肾病研究电子杂志, 2024, 13(03): 121-128.
[15] 唐小久, 胡曼, 许必君, 肖亚. 肥胖合并胃食管反流病患者严重程度与其焦虑抑郁及营养状态的相关性研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 360-364.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号