美国范德比尔特大学医学中心FredericTBillingsIV团队研究了手术及术后超生理氧给药是否会加剧器官损伤。2022年11月30日《英国医学杂志》发表了这一成果。
为了检查术中超生理氧给药是否与术后肾、心脏和肺损伤的降低或升高有关，研究组在美国各地参与多中心围手术期结果组数据登记的42个医疗中心进行了一项观察性队列研究。2016年1月至2018年11月，招募接受外科手术的成年患者，手术后入院的患者在全身麻醉和气管插管的情况下持续120分钟。
介入超生理氧给药，定义为在血红蛋白氧饱和度大于92%的几分钟内，吸入氧高于空气比例（21%）的曲线下面积。主要终点是使用肾脏疾病改善总体预后标准定义的急性肾损伤、手术72小时内血清肌钙蛋白>0.04ng/mL定义的心肌损伤以及使用国际疾病分类出院诊断代码定义的肺损伤。
与第25百分位的患者相比，吸入氧分数曲线下面积的第75百分位患者的急性肾损伤几率增加26%，心肌损伤几率增加12%，肺损伤几率增加14%。敏感性分析评估了暴露的替代定义，限制了队列，并进行了工具变量分析，证实了这些观察结果。
附：英文原文
Title:Oxygenadministrationduringsurgeryandpostoperativeorganinjury:observationalcohortstudy
Author:DavidRMcIlroy,MatthewSShotwell,MarcosGLopez,MichelleTVaughn,JoannaSOlsen,CassandraHennessy,JonathanPWanderer,MatthewSSemler,ToddWRice,SachinKheterpal,FredericTBillings
Issue&Volume:2022/11/30
Abstract:
ObjectiveToexaminewhethersupraphysiologicaloxygenadministrationduringsurgeryisassociatedwithlowerorhigherpostoperativekidney,heart,andlunginjury.
DesignObservationalcohortstudy.
Setting42medicalcentersacrosstheUnitedStatesparticipatingintheMulticenterPerioperativeOutcomesGroupdataregistry.
ParticipantsAdultpatientsundergoingsurgicalprocedures≥120minutes’durationwithgeneralanesthesiaandendotrachealintubationwhowereadmittedtohospitalaftersurgerybetweenJanuary2016andNovember2018.
InterventionSupraphysiologicaloxygenadministration,definedastheareaunderthecurveofthefractionofinspiredoxygenaboveair(21%)duringminuteswhenthehemoglobinoxygensaturationwasgreaterthan92%.
MainoutcomesPrimaryendpointswereacutekidneyinjurydefinedusingKidneyDiseaseImprovingGlobalOutcomescriteria,myocardialinjurydefinedasserumtroponin>0.04ng/mLwithin72hoursofsurgery,andlunginjurydefinedusinginternationalclassificationofdiseaseshospitaldischargediagnosiscodes.
ConclusionsIncreasedsupraphysiologicaloxygenadministrationduringsurgerywasassociatedwithahigherincidenceofkidney,myocardial,andlunginjury.Residualconfoundingoftheseassociationscannotbeexcluded.