The changes of intraoperative temperature and risk factors of prognosis of patients undergoing clipping of posterior communicating artery aneurysms_West China Medical Journal

Authors：

ZHI Lujun ¹ , YOU Chao ² , GONG Renrong ³ , CHENG Hua ¹ ,  SONG Jinping ⁴

1. Anesthesia Operations Centre, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Nursing Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SONG Jinping, Email: jinpings210@163.com

Keywords：

Intraoperative hypothermia; Posterior communicating artery aneurysms; Microsurgical clipping; Prognosis

DOI：

10.7507/1002-0179.201911160

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the changes of intraoperative temperature and influencing factors of the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms.Methods The basic clinic data and intraoperative temperature of patients undergoing elective clipping of posterior communicating artery aneurysms between October 2018 and July 2019 were collected, and the minimum intraoperative temperature was categorized into ≥36.0 and <37.5℃, ≥35.0 and <36.0℃, and <35.0℃. According to the Glasgow outcome scale (GOS) at discharge, the patients were divided into good prognosis group (GOS 4-5) and bad prognosis group (GOS 1-3). Multiple logistic regression analysis was used to obtain the risk factors of short-term prognosis.Results A total of 127 cases were involved, and intraoperative hypothermia (<36.0℃) occurred in 64 cases (50.4%). The intraoperative temperature presented classical three-phrase changes, i.e. it dropped rapidly at 1 hour after anesthesia introduction, decreased slowly during 2-3 hours after anesthesia introduction, and then entered the plateau. In the 127 cases, 93 (73.2%) had good prognosis, with an intraoperative hypothermia proportion of 44.1% (41/93); and 34 (26.8%) had bad prognosis, with an intraoperative hypothermia proportion of 67.6% (23/34). Univariate analysis showed that Hunt-Hess grade (χ²=18.999, P<0.001), intraoperative bleeding (χ²=7.074, P=0.008), minimum intraoperative temperature (Z=−3.473, P=0.001), and postoperative complications (χ²=43.060, P<0.001) were related to the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms. Multiple logistic regression analysis presented that high Hunt-Hess grade (Ⅳ, Ⅴ) [odds ratio (OR)=6.456, 95% confidence interval (CI) (1.141, 36.532), P=0.035], the minimum intraoperative temperature <35.0℃ [OR=7.552, 95%CI (1.450, 39.345), P=0.016], and postoperative complications [OR=22.866, 95%CI (6.778, 77.142), P<0.001] were independent risk factors of the short-term prognosis. The difference in short-term prognosis between patients with the minimum intraoperative temperature ≥35.0 and <36.0℃ and the ones with the minimum intraoperative temperature ≥36.0 and <37.5℃ was not statistically significant (P>0.05).Conclusions The minimum intraoperative temperature<35.0℃ and postoperative complications were changeable factors to effect progonosis of patients undergoing elective clipping of posterior communicating artery aneurysms. Clinical staff should set medical intervention measures based on the individual conditions of patients to improve patients’ quality of life.

Citation： ZHI Lujun, YOU Chao, GONG Renrong, CHENG Hua, SONG Jinping. The changes of intraoperative temperature and risk factors of prognosis of patients undergoing clipping of posterior communicating artery aneurysms. West China Medical Journal, 2020, 35(3): 336-341. doi: 10.7507/1002-0179.201911160 Copy

1.	Chen SF, Kato Y, Kumar A, et al. Intraoperative rupture in the surgical treatment of patients with intracranial aneurysms. J Clin Neurosci, 2016, 34: 63-69.
2.	Stapleton CJ, Walcott BP, Butler WE, et al. Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms. J Neurosurg, 2015, 122(1): 128-135.
3.	Kinshuk S, Pandey AS, Thompson BG, et al. Intraoperative monitoring for intracranial aneurysms: the Michigan experience. J Clin Neurophysiol, 2014, 31(6): 563-567.
4.	郑匡, 田作富, 谭显西, 等. 早期治疗高分级动脉瘤性蛛网膜下腔出血一年预后因素多中心研究. 中华外科杂志, 2016, 54(7): 534-539.
5.	Erecinska M, Thoresen M, Silver IA. Effects of hypothermia on energy metabolism in Mammalian central nervous system. J Cereb Blood Flow Metab, 2003, 23(5): 513-530.
6.	Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology, 2008, 109(2): 318-338.
7.	Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiol Intensive Ther, 2013, 45(1): 38-43.
8.	Yi J, Xiang Z, Deng X, et al. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Beijing: a prospective regional survey. PLoS One, 2015, 10(9): e0136136.
9.	苏文杰, 兰志勋. 全麻患者术中低体温的处理. 实用医院临床杂志, 2014, 11(2): 159-161.
10.	Sessler DI. Perioperative heat balance. Anesthesiology, 2000, 92(2): 578-596.
11.	贺丽, 张亚丽, 曹书奎, 等. 心肺脑复苏患者采用组合式降温技术行脑保护的可行性研究. 中国实用神经疾病杂志, 2017, 20(1): 30-32.
12.	杨传忠, 朱小瑜. 亚低温治疗与脑保护. 中华实用儿科临床杂志, 2014, 29(2): 86-89.
13.	Andresen M, Gazmuri JT, Marín A, et al. Therapeutic hypothermia for acute brain injuries. Scand J Trauma Resusc Emerg Med, 2015, 23: 42.
14.	Mancuso A, Derugin N, Hara K, et al. Mild hypothermia decreases the incidence of transient ADC reduction detected with diffusion MRI and expression of c-fos and hsp70 mRNA during acute focal ischemia in rats. Brain Res, 2000, 887(1): 34-45.
15.	Takashi H, Katsuyoshi S, Ogino M, et al. Postischemic hypothermia inhibits the generation of hydroxyl radical following transient forebrain ischemia in rats. J Neurotrauma, 2003, 20(5): 511-520.
16.	江淦, 龚如, 江基尧. 高热和亚低温对颅脑创伤后血脑屏障的影响及其机制. 中华创伤杂志, 2012, 28(3): 225-226.
17.	Luan X, Li J, McAllister J, et al. Regional brain cooling induced by vascular saline infusion into ischemic territory reduces brain inflammation in stroke. Acta Neuropathol, 2004, 107(3): 227-234.
18.	Yenari MA, Iwayama S, Cheng D, et al. Mild hypothermia attenuates cytochrome C release but does not alter Bcl-2 expression or caspase activation after experimental stroke. J Cereb Blood Flow Metab, 2002, 22(1): 29-38.
19.	董斌, 徐英辉, 罗其中, 等. 猪深低温停循环长程时间窗脑保护机制研究. 中华神经外科杂志, 2004, 20(6): 467-470.
20.	Duz B, Oztas E, Erginay T, et al. The effect of moderate hypothermia in acute ischemic stroke on pericyte migration: an ultrastructural study. Cryobiology, 2007, 55(3): 279-284.
21.	胡骁, 代永庆, 陈士新, 等. 局部亚低温对脑梗死患者的脑保护机制的临床研究. 重庆医学, 2016(34): 4817-4819.
22.	Todd MM, Hindman BJ, Clarke WR, et al. Mild intraoperative hypothermia during surgery for intracranial aneurysm. Acc Curr J Rev, 2005, 14(5): 135-145.
23.	胡玲, 卢昌懿, 杨翠凤, 等. 抗菌手术薄膜在预防神经外科手术部位感染效果研究. 中国感染控制杂志, 2015, 14(6): 389-392.
24.	董妞, 商临萍, 付秀荣, 等. 充气加温毯在神经外科脑膜瘤切除病人护理中的应用研究. 护理研究, 2017, 31(31): 3976-3978.
25.	王跃飞, 孟亮, 余小祥, 等. 高分级动脉瘤性蛛网膜下腔出血的早期手术治疗. 中国现代医学杂志, 2017, 27(21): 99-103.
26.	Rahmanian A, Derakhshan N, Sisakht AM, et al. Risk factors for unfavorable outcome in aneurysmal subarachnoid hemorrhage revisited; odds and ends. Bull Emerg Trauma, 2018, 6(2): 133-140.
27.	Park JH, Kim YI, Lim YC. Clinical outcomes of treatment for intracranial aneurysm in elderly patients. J Cerebrovasc Endovasc Neurosurg, 2014, 16(3): 193-199.
28.	Dubow J, Fink ME. Impact of hypertension on stroke. Curr Atheroscler Rep, 2011, 13(4): 298-305.
29.	Schuette AJ, Barrow DL, Cohen-Gadol AA. Strategies to minimize complications during intraoperative aneurysmal hemorrhage: a personal experience. World Neurosurg, 2015, 83(4): 620-626.
30.	王青美. 脑溢血病人医院感染及护理措施. 中国消毒学杂志, 2013, 30(6): 570-571.
31.	齐文涛, 彭爱军, 曹德茂, 等. 破裂大脑中动脉动脉瘤的外科手术治疗: 临床转归和预后因素. 国际脑血管病杂志, 2017, 25(11): 1023-1030.
32.	Kumar A, Brown R, Dhar R, et al. Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery, 2013, 73(4): 617-623; discussion 623.

1. Chen SF, Kato Y, Kumar A, et al. Intraoperative rupture in the surgical treatment of patients with intracranial aneurysms. J Clin Neurosci, 2016, 34: 63-69.
2. Stapleton CJ, Walcott BP, Butler WE, et al. Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms. J Neurosurg, 2015, 122(1): 128-135.
3. Kinshuk S, Pandey AS, Thompson BG, et al. Intraoperative monitoring for intracranial aneurysms: the Michigan experience. J Clin Neurophysiol, 2014, 31(6): 563-567.
4. 郑匡, 田作富, 谭显西, 等. 早期治疗高分级动脉瘤性蛛网膜下腔出血一年预后因素多中心研究. 中华外科杂志, 2016, 54(7): 534-539.
5. Erecinska M, Thoresen M, Silver IA. Effects of hypothermia on energy metabolism in Mammalian central nervous system. J Cereb Blood Flow Metab, 2003, 23(5): 513-530.
6. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology, 2008, 109(2): 318-338.
7. Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiol Intensive Ther, 2013, 45(1): 38-43.
8. Yi J, Xiang Z, Deng X, et al. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Beijing: a prospective regional survey. PLoS One, 2015, 10(9): e0136136.
9. 苏文杰, 兰志勋. 全麻患者术中低体温的处理. 实用医院临床杂志, 2014, 11(2): 159-161.
10. Sessler DI. Perioperative heat balance. Anesthesiology, 2000, 92(2): 578-596.
11. 贺丽, 张亚丽, 曹书奎, 等. 心肺脑复苏患者采用组合式降温技术行脑保护的可行性研究. 中国实用神经疾病杂志, 2017, 20(1): 30-32.
12. 杨传忠, 朱小瑜. 亚低温治疗与脑保护. 中华实用儿科临床杂志, 2014, 29(2): 86-89.
13. Andresen M, Gazmuri JT, Marín A, et al. Therapeutic hypothermia for acute brain injuries. Scand J Trauma Resusc Emerg Med, 2015, 23: 42.
14. Mancuso A, Derugin N, Hara K, et al. Mild hypothermia decreases the incidence of transient ADC reduction detected with diffusion MRI and expression of c-fos and hsp70 mRNA during acute focal ischemia in rats. Brain Res, 2000, 887(1): 34-45.
15. Takashi H, Katsuyoshi S, Ogino M, et al. Postischemic hypothermia inhibits the generation of hydroxyl radical following transient forebrain ischemia in rats. J Neurotrauma, 2003, 20(5): 511-520.
16. 江淦, 龚如, 江基尧. 高热和亚低温对颅脑创伤后血脑屏障的影响及其机制. 中华创伤杂志, 2012, 28(3): 225-226.
17. Luan X, Li J, McAllister J, et al. Regional brain cooling induced by vascular saline infusion into ischemic territory reduces brain inflammation in stroke. Acta Neuropathol, 2004, 107(3): 227-234.
18. Yenari MA, Iwayama S, Cheng D, et al. Mild hypothermia attenuates cytochrome C release but does not alter Bcl-2 expression or caspase activation after experimental stroke. J Cereb Blood Flow Metab, 2002, 22(1): 29-38.
19. 董斌, 徐英辉, 罗其中, 等. 猪深低温停循环长程时间窗脑保护机制研究. 中华神经外科杂志, 2004, 20(6): 467-470.
20. Duz B, Oztas E, Erginay T, et al. The effect of moderate hypothermia in acute ischemic stroke on pericyte migration: an ultrastructural study. Cryobiology, 2007, 55(3): 279-284.
21. 胡骁, 代永庆, 陈士新, 等. 局部亚低温对脑梗死患者的脑保护机制的临床研究. 重庆医学, 2016(34): 4817-4819.
22. Todd MM, Hindman BJ, Clarke WR, et al. Mild intraoperative hypothermia during surgery for intracranial aneurysm. Acc Curr J Rev, 2005, 14(5): 135-145.
23. 胡玲, 卢昌懿, 杨翠凤, 等. 抗菌手术薄膜在预防神经外科手术部位感染效果研究. 中国感染控制杂志, 2015, 14(6): 389-392.
24. 董妞, 商临萍, 付秀荣, 等. 充气加温毯在神经外科脑膜瘤切除病人护理中的应用研究. 护理研究, 2017, 31(31): 3976-3978.
25. 王跃飞, 孟亮, 余小祥, 等. 高分级动脉瘤性蛛网膜下腔出血的早期手术治疗. 中国现代医学杂志, 2017, 27(21): 99-103.
26. Rahmanian A, Derakhshan N, Sisakht AM, et al. Risk factors for unfavorable outcome in aneurysmal subarachnoid hemorrhage revisited; odds and ends. Bull Emerg Trauma, 2018, 6(2): 133-140.
27. Park JH, Kim YI, Lim YC. Clinical outcomes of treatment for intracranial aneurysm in elderly patients. J Cerebrovasc Endovasc Neurosurg, 2014, 16(3): 193-199.
28. Dubow J, Fink ME. Impact of hypertension on stroke. Curr Atheroscler Rep, 2011, 13(4): 298-305.
29. Schuette AJ, Barrow DL, Cohen-Gadol AA. Strategies to minimize complications during intraoperative aneurysmal hemorrhage: a personal experience. World Neurosurg, 2015, 83(4): 620-626.
30. 王青美. 脑溢血病人医院感染及护理措施. 中国消毒学杂志, 2013, 30(6): 570-571.
31. 齐文涛, 彭爱军, 曹德茂, 等. 破裂大脑中动脉动脉瘤的外科手术治疗: 临床转归和预后因素. 国际脑血管病杂志, 2017, 25(11): 1023-1030.
32. Kumar A, Brown R, Dhar R, et al. Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery, 2013, 73(4): 617-623; discussion 623.

West China Medical Journal

The changes of intraoperative temperature and risk factors of prognosis of patients undergoing clipping of posterior communicating artery aneurysms

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content