美国范德比尔特大学医学中心Frederic T Billings IV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>0.04 ng/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。

该队列包括350647名患者，中位年龄为59岁，180546名为女性（51.5%），中位手术时间为205分钟。297554名患者中有19207名（6.5%）被诊断为急性肾损伤，320527名中有8972名被诊断为心肌损伤（2.8%），312161名中有13789名被诊断出肺损伤（4.4%）。

吸入氧的中位分数为54.0%，超生理吸入氧气曲线下面积为7951%分钟，相当于整个135分钟过程中吸入80%的氧气。在考虑基线协变量和其他潜在混杂变量后，氧暴露增加与急性肾损伤、心肌损伤和肺损伤的风险增加相关。

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。

研究结果表明，手术期间增加超生理氧给药与肾脏、心肌和肺损伤的发生率较高相关。但尚不能排除这些关联的残余混淆。

附：英文原文

Title: Oxygen administration during surgery and postoperative organ injury: observational cohort study

Author: David R McIlroy, Matthew S Shotwell, Marcos G Lopez, Michelle T Vaughn, Joanna S Olsen, Cassandra Hennessy, Jonathan P Wanderer, Matthew S Semler, Todd W Rice, Sachin Kheterpal, Frederic T Billings

Issue&Volume: 2022/11/30

Abstract:

Objective To examine whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury.

Design Observational cohort study.

Setting 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry.

Participants Adult patients undergoing surgical procedures ≥120 minutes’ duration with general anesthesia and endotracheal intubation who were admitted to hospital after surgery between January 2016 and November 2018.

Intervention Supraphysiological oxygen administration, defined as the area under the curve of the fraction of inspired oxygen above air (21%) during minutes when the hemoglobin oxygen saturation was greater than 92%.

Main outcomes Primary endpoints were acute kidney injury defined using Kidney Disease Improving Global Outcomes criteria, myocardial injury defined as serum troponin >0.04 ng/mL within 72 hours of surgery, and lung injury defined using international classification of diseases hospital discharge diagnosis codes.

Results The cohort comprised 350647 patients with median age 59 years (interquartile range 46-69 years), 180546 women (51.5%), and median duration of surgery 205 minutes (interquartile range 158-279 minutes). Acute kidney injury was diagnosed in 19207 of 297554 patients (6.5%), myocardial injury in 8972 of 320527 (2.8%), and lung injury in 13789 of 312161 (4.4%). The median fraction of inspired oxygen was 54.0% (interquartile range 47.5%-60.0%), and the area under the curve of supraphysiological inspired oxygen was 7951% min (5870-11107% min), equivalent to an 80% fraction of inspired oxygen throughout a 135 minute procedure, for example. After accounting for baseline covariates and other potential confounding variables, increased oxygen exposure was associated with a higher risk of acute kidney injury, myocardial injury, and lung injury. Patients at the 75th centile for the area under the curve of the fraction of inspired oxygen had 26% greater odds of acute kidney injury (95% confidence interval 22% to 30%), 12% greater odds of myocardial injury (7% to 17%), and 14% greater odds of lung injury (12% to 16%) compared with patients at the 25th centile. Sensitivity analyses evaluating alternative definitions of the exposure, restricting the cohort, and conducting an instrumental variable analysis confirmed these observations.

Conclusions Increased supraphysiological oxygen administration during surgery was associated with a higher incidence of kidney, myocardial, and lung injury. Residual confounding of these associations cannot be excluded.

DOI: 10.1136/bmj-2022-070941

Source: https://www.bmj.com/content/379/bmj-2022-070941