Pearse Rupert, Dawson Deborah, Fawcett Jayne, Rhodes Andrew, Grounds R Michael, Bennett E David
Adult Intensive Care Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
Crit Care. 2005;9(6):R694-9. doi: 10.1186/cc3888. Epub 2005 Nov 8.
Despite recent interest in measurement of central venous oxygen saturation (ScvO2), there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome.
ScvO2 and other biochemical, physiological and demographic data were prospectively measured for 8 hours after major surgery. Complications and deaths occurring within 28 days of enrollment were included in the data analysis. Independent predictors of complications were identified with the use of logistic regression analysis. Optimum cutoffs for ScvO2 were identified by receiver operator characteristic analysis.
Data from 118 patients was analysed; 123 morbidity episodes occurred in 64 these patients. There were 12 deaths (10.2%). The mean +/- SD age was 66.8 +/- 11.4 years. Twenty patients (17%) underwent emergency surgery and 77 patients (66%) were male. The mean +/- SD P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity) score was 38.6 +/- 7.7, with a predicted mortality of 16.7 +/- 17.6%. After multivariate analysis, the lowest cardiac index value (odds ratio (OR) 0.58 (95% confidence intervals 0.37 to 0.9); p = 0.018), lowest ScvO2 value (OR 0.94 (0.89 to 0.98); p = 0.007) and P-POSSUM score (OR 1.09 (1.02 to 1.15); p = 0.008) were independently associated with post-operative complications. The optimal ScvO2 cutoff value for morbidity prediction was 64.4%. In the first hour after surgery, significant reductions in ScvO2 were observed, but there were no significant changes in CI or oxygen delivery index during the same period.
Significant fluctuations in ScvO2 occur in the immediate post-operative period. These fluctuations are not always associated with changes in oxygen delivery, suggesting that oxygen consumption is also an important determinant of ScvO2. Reductions in ScvO2 are independently associated with post-operative complications.
尽管近期对中心静脉血氧饱和度（ScvO2）的测量颇感兴趣，但尚无已发表的数据描述大手术后ScvO2的变化模式或其与预后的任何关系。
对大手术后8小时的ScvO2及其他生化、生理和人口统计学数据进行前瞻性测量。纳入数据分析的是入组后28天内发生的并发症和死亡情况。使用逻辑回归分析确定并发症的独立预测因素。通过受试者工作特征分析确定ScvO2的最佳临界值。
分析了118例患者的数据；其中64例患者发生了123次发病事件。有死亡病例12例（10.2%）。平均年龄±标准差为66.8±11.4岁。20例患者（17%）接受了急诊手术，77例患者（66%）为男性。平均±标准差P-POSSUM（朴茨茅斯生理和手术严重程度评分系统，用于计算死亡率和发病率）评分为38.6±7.7，预测死亡率为16.7±17.6%。多因素分析后，最低心脏指数值（比值比（OR）0.58（95%置信区间0.37至0.9）；p = 0.018）、最低ScvO2值（OR 0.94（0.89至0.98）；p = 0.007）和P-POSSUM评分（OR 1.09（1.02至1.15）；p = 0.008）与术后并发症独立相关。预测发病的最佳ScvO2临界值为64.4%。术后第一小时观察到ScvO2显著降低，但同期心脏指数或氧输送指数无显著变化。
术后即刻ScvO2出现显著波动。这些波动并不总是与氧输送的变化相关，这表明氧消耗也是ScvO2的重要决定因素。ScvO2降低与术后并发症独立相关。
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