肥胖和非肥胖患者腹腔镜手术期间的组织氧合
Tissue oxygenation in obese and non-obese patients during laparoscopy.
作者信息
Fleischmann Edith, Kurz Andrea, Niedermayr Monika, Schebesta Karl, Kimberger Oliver, Sessler Daniel I, Kabon Barbara, Prager Gerhard
机构信息
Department of Anesthesia and Intensive Care, Medical University Vienna, Austria.
出版信息
Obes Surg. 2005 Jun-Jul;15(6):813-9. doi: 10.1381/0960892054222867.
BACKGROUND
Wound infection risk is inversely related to subcutaneous tissue oxygenation, which is reduced in obese patients and may be reduced even more during laparoscopic procedures.
METHODS
We evaluated subcutaneous tissue oxygenation (PsqO(2)) in 20 patients with a body mass index (BMI) > or=40 kg/m(2) (obese group) and 15 patients with BMI <30 kg/m(2) (non-obese group) undergoing laparoscopic surgery with standardized anaesthesia technique and fluid administration. Arterial oxygen tension was maintained near 150 mmHg. PsqO(2) was measured from a surrogate wound on the upper arm.
RESULTS
A mean FIO(2) of 51% (13%) was required in obese patients to reach an arterial oxygen tension of 150 mmHg; however, a mean FIO(2) of only 40% (7%) was required to reach the same oxygen tension in non-obese patients (P=0.007). PsqO(2) was significantly less in obese patients: 41 (10) vs 57 (15) mmHg (P<0.001).
CONCLUSION
Obese patients having laparoscopic surgery require a significantly greater FIO(2) to reach an arterial oxygen tension of about 150 mmHg than non-obese patients; they also have significantly lower subcutaneous oxygen tensions. Both factors probably contribute to an increased infection risk in obese patients.
背景
伤口感染风险与皮下组织氧合呈负相关，肥胖患者皮下组织氧合降低，在腹腔镜手术过程中可能降低得更多。
方法
我们评估了20例体重指数（BMI）≥40kg/m²的患者（肥胖组）和15例BMI＜30kg/m²的患者（非肥胖组）在接受标准化麻醉技术和液体输注的腹腔镜手术时的皮下组织氧合（PsqO₂）。动脉血氧张力维持在150mmHg左右。PsqO₂通过上臂的替代伤口进行测量。
结果
肥胖患者达到动脉血氧张力150mmHg平均需要51%（13%）的吸入氧浓度（FIO₂）；然而，非肥胖患者达到相同血氧张力平均仅需要40%（7%）的FIO₂（P = 0.007）。肥胖患者的PsqO₂显著更低：41（10）mmHg对57（15）mmHg（P＜0.001）。
结论
与非肥胖患者相比，肥胖患者进行腹腔镜手术时需要显著更高的FIO₂才能达到约150mmHg的动脉血氧张力；他们的皮下氧张力也显著更低。这两个因素可能都导致肥胖患者感染风险增加。
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