【目的】 探讨基于不同中医体质的老年全麻手术患者术中低体温（IH）发生特点及复温效果。【方法】 纳入2022年6月至 2022年11月经广州中医药大学第一附属医院接受全麻手术的患者共500例，按IH是否发生分为IH组及非IH组，收集2组患 者的基础资料，采用单因素和多因素Logistic回归模型分析老年全麻手术患者IH发生的影响因素，根据影响因素进行赋值构 建IH发生风险预警模型，经受试者工作曲线（ROC）评估模型诊断效能；同期选择50例老年全麻手术患者进行外部验证；并 于 2022年 12月至 2023年 2月纳入老年全麻手术伴 IH患者 80例，按随机数字表法分为对照组及观察组，对照组患者予以常 规保暖，观察组采用充气加温毯进行保暖，比较2组患者的复温效果。【结果】（1）500例老年全麻手术患者中180例出现IH， 发生率为36.0%。（2）除年龄、性别、手术类型、美国麻醉医师协会（ASA）分级、麻醉方式及液体总出量外，2组患者的体质 量指数（BMI）、中医体质类型、手术大小分级、术前核心体温、手术室温度、复温类型、手术时间、麻醉时间、液体总入 量、术中冲洗液量及术中输血比较，差异均有统计学意义（P＜0.05或P＜0.01）。（3）经多因素Logistic回归模型分析，老年全 麻手术患者IH发生的独立影响因素包括BMI、中医体质类型、手术大小分级、术前核心体温、手术室温度、复温类型、麻 醉时间、液体总入量及术中冲洗液量；经受试者工作曲线（ROC）分析，经构建风险评估模型的曲线下面积（AUC）值为0.816， 灵敏度、特异度分别为74.40%、77.50%。（4）同期选择50例老年全麻手术患者，术中发生IH 19例，未发生IH 31例，由外部 验证结果显示：经构建风险评估模型预测老年全麻手术 IH发生灵敏度、特异度分别为 73.68%、77.42%。（5）与对照组比较， 观察组患者入恢复室耳温更低，复温时间、麻醉恢复室停留时间更短，复温速度更快，寒战发生率更低，差异均有统计学 意义（P＜0.05或P＜0.01）。【结论】 老年全麻手术患者IH发生较为普遍，尤需对低BMI、气虚/阳虚/血虚中医体质、大手术、 术前核心体温低、手术室温度低、被动复温、麻醉时间长、液体总入量多、术中冲洗液量大的患者给予重点关注；经构建 的风险预警模型具有较高的诊断效能；针对老年全麻手术伴IH患者，及时采用充气加温毯进行保暖，可获良好复温效果。

Objective To investigate the incidence of intraoperative hypothermia （IH） and rewarming efficacy in elderly patients with different traditional Chinese medicine （TCM） constitutions undergoing general anesthesia. Methods A total of 500 elderly patients undergoing general anesthesia at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2022 to November 2022 were enrolled. The patients were divided into IH group and non-IH group depending on the occurrence of IH. Baseline data of the patients were collected， and univariate and multivariate logistic regression analyses were performed to identify risk factors for IH. A risk prediction model was constructed after value-assignment of influencing factors and its diagnostic efficiency was assessed by receiver operating characteristic （ROC） curve. External validation of the model was conducted in 50 elderly patients undergoing general anesthesia at the same period. From December 2022 to February 2023， 80 elderly patients undergoing general anesthesia and complicated with IH were randomized into a control group （routine measures for keeping warm） and an observation group （keeping warm with forced-air-warming blanket） to compare the rewarming efficacy. Results（1） Among 500 elderly patients undergoing general anesthesia，180 cases developed IH， with an incidence of 36.0%.（2） Except for age， sex， type of surgery， American Society of Anesthesiologists （ASA） classification，type of anesthesia，and total fluid output volume，statistically significant differences were presented in body mass index（BMI）， TCM constitution type， surgical complexity grading， preoperative core body temperature， operating room temperature， rewarming strategy， surgical duration， anesthesia duration， total fluid intake volume， intraoperative irrigation volume， and intraoperative blood transfusion between the two groups（P＜0.05 or P＜0.01）.（3） Multivariate logistic regression analysis identified BMI，TCM constitution type，surgical complexity grading，preoperative core body temperature，operating room temperature， rewarming strategy， anesthesia duration， total fluid intake volume， and intraoperative irrigation volume as independent influencing factors for the occurrence of IH in elderly patients undergoing general anesthesia. ROC curve analysis demonstrated that the area under the curve （AUC） of the constructed risk prediction model was 0.816，with a sensitivity of 74.40% and a specificity of 77.50%.（4） In an external validation cohort of 50 elderly patients undergoing general anesthesia （19 IH cases versus 31 non-IH cases），the constructed risk prediction model exhibited a sensitivity of 73.68% and a specificity of 77.42%.（5） The observation group exhibited lower tympanic temperature upon post-anesthesia care unit （PACU） admission，shorter rewarming time and PACU stay duration， faster rewarming rate， and lower incidence of shivering than the control group， the differences being statistically significant （P＜0.05 or P＜0.01）. Conclusion IH is common in elderly patients undergoing general anesthesia，particularly in those under the conditions of low BMI，qi/yang/blood deficiency constitutions，major surgery，low preoperative core body temperature，low operating room temperature，passive rewarming，prolonged anesthesia，high fluid intake volume，and high and intraoperative irrigation volume. The constructed risk prediction model demonstrates favorable diagnostic performance. Proactive use of forced-airwarming blankets effectively improves rewarming outcomes in elderly patients undergoing general anesthesia and complicated with IH.

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广东省中医药局科研项目（编号：20222055）；广州市科技计划项目（编号：2025A03J3582)