氧儲備指數作為術后補充氧氣必要量的決定因素

氧儲備指數作為術后補充氧氣必要量的決定因素

貴州醫科大學 麻醉與心臟電生理課題組

翻譯：李奕 編輯：馬艷燕 審校：曹瑩

背景：雖然血氣分析（BGA）對補充吸氧很重要，但它是有創的、間歇性的、昂貴的，并且對工作人員來說是負擔。我們評估了氧儲備指數（ORi™），它是一種基于脈搏血氧計的、可以反映氧分壓（PaO2）的新指數，并且可以確定術后補充氧的量。還評估了高氧和缺氧的程度。

方法：將50名接受乳腺手術的患者隨機分為ORi-based氧氣組（O組）或常規術后氧氣組（C組）。術后將患者送往麻醉監護室（PACU），然后再送回普通病房。在O組中，拔管后在手術室以4L/min給氧，如果ORi大于0.00，則減少給氧，直到在PACU和病房的30分鐘內持續指數達到0.00。C組在整個評估期間以4L/min的濃度給氧。麻醉誘導后（T0）、拔管后（T1）、離開PACU前（T2）和術后第一天早上（T3）進行BGA。從手術后當天晚上9點到第二天早上6點，每兩秒測量一次經皮血氧飽和度。

結果：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；中位數[四分位間距]和平均值[1 SD]；P<0.01）時，O組的補充氧氣量和PaO2顯著低于C組。無患者出現缺氧。

結論：基于我們的研究結果，ORi可能有助于補充術后吸入氧氣量。

原始文獻來源：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.