食管癌根治术中的时间分段、反馈引导的分层加温：一项单中心回顾性队列研究

文献信息

中文摘要

目的： 评估基于时间分段预警阈值和分层、反馈引导加温干预的方案化术中体温管理策略是否能减少接受食管癌根治术患者的低体温并改善术后早期恢复。

方法： 这项单中心回顾性比较队列研究纳入2024年8月至2026年1月在西南医科大学附属医院接受择期食管癌根治术的116例成人患者，分别接受时间分段、反馈引导的分层加温方案（n = 58）或常规加温（n = 58）。核心体温通过下段食管探头持续监测直至开始游离食管，此后改用鼻咽探头监测，并每15分钟记录一次。所有加温调整均由临床团队根据预先设定的阈值手动实施。主要终点为术中低体温，定义为从切皮至皮肤缝合期间任何时间核心体温低于36 °C。次要终点包括重度低体温、最低体温、低体温负荷、术后寒战、拔管时间、麻醉后监护室（PACU）恢复时间、凝血指标、30天并发症、住院时间和住院费用。

结果： 术中低体温发生于58例对照患者中的53例（91.4%）和58例干预患者中的5例（8.6%）（风险比0.09，95% CI 0.04-0.22；P < 0.001）。低于35.5 °C的重度低体温发生于27例对照患者（46.6%），干预患者中无一例发生。对照组中位最低核心体温为35.55 °C，干预组为36.27 °C（P < 0.001）。与常规加温相比，该方案减少了术后寒战（5.2% vs 51.7%），将拔管时间缩短了8.9分钟，降低了任何术后并发症的发生率（34.5% vs 62.1%；P = 0.005），缩短了住院时间（12.2 vs 13.5天；P = 0.010），并将平均住院费用降低了8,911元人民币（P < 0.001）。在使用Firth惩罚logistic回归（校正比值比0.004，95% CI 0.000-0.024）和改良Poisson回归（校正风险比0.10，95% CI 0.04-0.23）的校正分析中，治疗效果基本不变。

结论： 在接受食管癌根治术的成人中，时间分段、反馈引导的分层加温方案显著减少了术中低体温，并与更快的早期恢复、更少的术后并发症、更短的住院时间和更低的费用相关。由于该干预是一个多组分加温组合方案，无法区分其各单独组分的贡献，且与并发症、住院时间和费用的关联应被视为产生假设。该方案使用标准围手术期设备，无需专用硬件即可实施。

英文摘要

OBJECTIVE: To evaluate whether a protocolized intraoperative temperature-management strategy based on time-segmented warning thresholds and tiered, feedback-guided warming interventions reduces hypothermia and improves early postoperative recovery in patients undergoing radical esophagectomy.
METHODS: This single-center retrospective comparative cohort study included 116 adults who underwent elective radical esophagectomy at The affiliated Hospital of Southwest Medical University between August 2024 and January 2026 and were managed with either a time-segmented, feedback-guided tiered warming protocol (n = 58) or conventional warming (n = 58). Core temperature was monitored continuously with a lower esophageal probe until the start of esophageal mobilization and with a nasopharyngeal probe thereafter, and was recorded every 15 min. All warming adjustments were implemented manually by the clinical team according to predefined thresholds. The primary endpoint was intraoperative hypothermia, defined as a core temperature below 36 °C at any time from incision to skin closure. Secondary endpoints included severe hypothermia, nadir temperature, hypothermia burden, postoperative shivering, time to extubation, post-anesthesia care unit (PACU) recovery time, coagulation indices, 30-day complications, length of stay, and hospital cost.
RESULTS: Intraoperative hypothermia occurred in 53 of 58 control patients (91.4%) and 5 of 58 intervention patients (8.6%) (risk ratio 0.09, 95% CI 0.04-0.22; P < 0.001). Severe hypothermia below 35.5 °C developed in 27 control patients (46.6%) and in none of the intervention patients. Median nadir core temperature was 35.55 °C in the control group and 36.27 °C in the intervention group (P < 0.001). Compared with conventional warming, the protocol reduced postoperative shivering (5.2% vs 51.7%), shortened time to extubation by 8.9 min, lowered the rate of any postoperative complication (34.5% vs 62.1%; P = 0.005), shortened hospital stay (12.2 vs 13.5 days; P = 0.010), and reduced mean in-hospital cost by 8,911 CNY (P < 0.001). The treatment effect was materially unchanged in adjusted analyses using Firth penalized logistic regression (adjusted odds ratio 0.004, 95% CI 0.000-0.024) and modified Poisson regression (adjusted risk ratio 0.10, 95% CI 0.04-0.23).
CONCLUSION: In adults undergoing radical esophagectomy, a time-segmented, feedback-guided tiered warming protocol substantially reduced intraoperative hypothermia and was associated with faster early recovery, fewer postoperative complications, shorter hospitalization, and lower cost. Because the intervention was a multicomponent warming bundle, the contributions of its individual components cannot be separated, and the associations with complications, hospital stay, and cost should be regarded as hypothesis-generating. The protocol uses standard perioperative equipment and can be implemented without specialized hardware.