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氧储备指数作为术后补充氧气必要量的决定因素

氧储备指数作为术后补充氧气必要量的决定因素


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贵州医科大学 麻醉与心脏电生理课题组

翻译:李奕  编辑:马艳燕  审校:曹莹

背景:虽然血气分析(BGA)对补充吸氧很重要,但它是有创的、间歇性的、昂贵的,并且对工作人员来说是负担。我们评估了氧储备指数(ORi™),它是一种基于脉搏血氧计的、可以反映氧分压(PaO2)的新指数,并且可以确定术后补充氧的量。还评估了高氧和缺氧的程度。

方法:将50名接受乳腺手术的患者随机分为ORi-based氧气组(O组)或常规术后氧气组(C组)。术后将患者送往麻醉监护室(PACU),然后再送回普通病房。在O组中,拔管后在手术室以4L/min给氧,如果ORi大于0.00,则减少给氧,直到在PACU和病房的30分钟内持续指数达到0.00。C组在整个评估期间以4L/min的浓度给氧。麻醉诱导后(T0)、拔管后(T1)、离开PACU前(T2)和术后第一天早上(T3)进行BGA。从手术后当天晚上9点到第二天早上6点,每两秒测量一次经皮血氧饱和度。

结果:在T2(1.5[0.5-3.0]vs.4.0[4.0-4.0]L/min,117.3[26.8]vs.170.0[42.8]mmHg)和T3(1.0[0.5-3.0]vs.4.0+4.0]L/min 107.5[16.5]vs.157.1[28.4]mmHg;中位数[四分位间距]和平均值[1 SD];P<0.01)时,O组的补充氧气量和PaO2显著低于C组。无患者出现缺氧。

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结论:基于我们的研究结果,ORi可能有助于补充术后吸入氧气量。

原始文献来源:Motoi Kumagai , Hiroto Kurihara , Kazushige Ishida, et al. The Oxygen Reserve Index as a determinant of the necessary amount of postoperative supplemental oxygen.[J].Minerva Anestesiol. 2021 Apr;87(4):439-447.

英文     

The Oxygen Reserve Index as a determinant of the necessary amount of postoperative supplemental oxygen

Background: although blood gas analysis (Bga) is important for supplemental oxygen titration, it is invasive, intermittent, costly, and burdensome for staff. We assessed whether the oxygen reserve index (ori™), a novel pulse oximeter-based index that reflects the partial pressure of oxygen (PaO2), could determine the amount of postoperative supplemental oxygen. We also evaluated the extent of hyperoxia and hypoxia.

Method:Fifty patients scheduled to undergo breast surgery were randomly assigned to receive ori-based oxygen (group O) or conventional postoperative oxygen (group C) treatments. Postoperatively, patients were transported to the Post-Anesthesia Care Unit (PACU) and then to general wards. In group O, oxygen was administered at 4 L·min-1 in the operation room after extubation and was decreased if the ori was >0.00 until a continuous index of 0.00 was achieved for 30 min in the PACU and wards. In group C, oxygen was administered at 4 L·min-1 throughout the evaluation period. BGA was performed 1 h after anesthesia induction (T0), after extubation (T1), before PACU exit (T2), and on the first postoperative morning (T3). Percutaneous oxygen saturation was measured every two seconds from 9 PM after surgery to 6 aM the next morning.

Results:The supplemental oxygen amount and PaO2 were significantly lower in group O than group C at T2 (1.5 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 117.3 [26.8] vs. 170.0 [42.8] mmHg) and T3 (1.0 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 107.5 [16.5] vs. 157.1 [28.4] mmHg; median [interquartile ranges] and mean [1 SD]; P<0.01). No patient exhibited hypoxia.

Conclusion:Based on our results, ori might be useful to titrate postoperative oxygen supplementation.



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