Qadeer Mohammed A, Rocio Lopez A, Dumot John A, Vargo John J
Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A 30, Cleveland, OH 44195, USA.
Dig Dis Sci. 2009 May;54(5):1035-40. doi: 10.1007/s10620-008-0452-2. Epub 2008 Nov 12.
Most studies identify the American Society of Anesthesiology (ASA) classification as the most significant risk factor for hypoxemia. The risk factors operative within ASA I and II patients are not well defined. Therefore, we analyzed prospectively collected data to identify the risk factors of hypoxemia in such patients.
A combination of a narcotic and benzodiazepine was used for sedation and oxygen was supplemented if hypoxemia (oxygen saturation <or=90%) developed. Univariate and multivariate analyses were performed and correlations estimated for predetermined clinical variables.
40 of 79 patients (51%) developed hypoxemia, which occurred more frequently in the obese (71%; 10/14) than the nonobese (46%; 30/65) group (P=0.08). On multivariate analysis, the odds ratios (OR) and 95% confidence intervals (CI) for developing hypoxemia were age >or= 60 years 4.5 (1.4-14.3) P=0.01, and incremental 25-mg doses of meperidine 2.6 (1.02-6.6) P = 0.04. Body mass index (BMI) significantly correlated with the number of hypoxemic episodes (rho 0.26, 95% CI 0.04-0.48, P=0.02).
In ASA I and II patients, BMI significantly correlated with the number of hypoxemic episodes, whereas age >or= 60 years and meperidine dose were significant risk factors for hypoxemia.
大多数研究认为美国麻醉医师协会（ASA）分级是低氧血症最重要的危险因素。ASA I级和II级患者中起作用的危险因素尚未明确界定。因此，我们对前瞻性收集的数据进行分析，以确定此类患者发生低氧血症的危险因素。
使用麻醉剂和苯二氮卓类药物联合进行镇静，若出现低氧血症（氧饱和度≤90%）则补充氧气。对预定的临床变量进行单因素和多因素分析，并估计相关性。
79例患者中有40例（51%）发生低氧血症，肥胖组（71%；10/14）比非肥胖组（46%；30/65）更常见（P = 0.08）。多因素分析显示，发生低氧血症的比值比（OR）及95%置信区间（CI）为年龄≥60岁4.5（1.4 - 14.3），P = 0.01；哌替啶每增加25mg剂量2.6（1.02 - 6.6），P = 0.04。体重指数（BMI）与低氧血症发作次数显著相关（rho 0.26，95%CI 0.04 - 0.48，P = 0.02）。
在ASA I级和II级患者中，BMI与低氧血症发作次数显著相关，而年龄≥60岁和哌替啶剂量是低氧血症的重要危险因素。
