Pedersen Tom, Møller Ann Merete, Hovhannisyan Karen
Head and Orthopaedic Center, Rigshospitalet, HOC 2101, Rigshospitalet, University of Copenhagen,Blegdamsvej 9, Copenhagen Ø, Denmark, DK-2100.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD002013. doi: 10.1002/14651858.CD002013.pub2.
Pulse oximetry is extensively used in the perioperative period and might improve patient outcomes by enabling an early diagnosis and, consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomized clinical trials of pulse oximetry during anaesthesia and in the recovery room have been performed that describe perioperative hypoxaemic events, postoperative cardiopulmonary complications, and cognitive dysfunction.
The objective of this review was to assess the effects of perioperative monitoring with pulse oximetry and to clearly identify the adverse outcomes that might be prevented or improved by the use of pulse oximetry.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to May 2009), ISI Web of Science (1956 to May 2009), LILACS (1982 to May 2009), and databases of ongoing trials; and checked the reference lists of trials and review articles.
We included all controlled trials that randomized patients to either pulse oximetry or no pulse oximetry during the perioperative period.
Two authors independently assessed data in relation to events detectable by pulse oximetry, any serious complications that occurred during anaesthesia or in the postoperative period, and intra- or postoperative mortality.
Searching identified five reports. We considered the studies with data from a total of 22,992 patients that were eligible for analysis. Results indicated that hypoxaemia was reduced in the pulse oximetry group, both in the operating theatre and in the recovery room. During observation in the recovery room, the incidence of hypoxaemia in the pulse oximetry group was 1.5 to three times less. Postoperative cognitive function was independent of perioperative monitoring with pulse oximetry. The one study in general surgery showed that postoperative complications occurred in 10% of the patients in the oximetry group and in 9.4% in the control group. No statistically significant differences were detected in cardiovascular, respiratory, neurologic, or infectious complications in the two groups. The duration of hospital stay was a median of five days in both groups, and an equal number of in-hospital deaths was registered in the two groups. Continuous pulse oximetry has the potential to increase vigilance and decrease pulmonary complications after cardiothoracic surgery, however routine continuous monitoring did not reduce transfer to an intensive care unit (ICU) or overall mortality.
AUTHORS' CONCLUSIONS: The studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we have found no evidence that pulse oximetry affects the outcome of anaesthesia for patients. The conflicting subjective and objective results of the studies, despite an intense methodical collection of data from a relatively large general surgery population, indicate that the value of perioperative monitoring with pulse oximetry is questionable in relation to improved reliable outcomes, effectiveness, and efficiency. Routine continuous pulse oximetry monitoring did not reduce either transfer to ICU or mortality, and it is unclear if there is any real benefit from the application of this technology in patients who are recovering from cardiothoracic surgery in a general care area.
脉搏血氧饱和度测定法在围手术期被广泛应用，通过早期诊断并进而纠正可能导致术后并发症甚至死亡的围手术期事件，可能改善患者预后。仅进行了少数关于麻醉期间及恢复室中脉搏血氧饱和度测定法的随机临床试验，这些试验描述了围手术期低氧血症事件、术后心肺并发症及认知功能障碍。
本综述的目的是评估围手术期使用脉搏血氧饱和度测定法进行监测的效果，并明确使用脉搏血氧饱和度测定法可能预防或改善的不良结局。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2009年第2期）、MEDLINE（1966年至2009年5月）、EMBASE（1980年至2009年5月）、护理学与健康领域数据库（CINAHL）（1982年至2009年5月）、科学引文索引（ISI Web of Science）（1956年至2009年5月）、拉丁美洲及加勒比地区健康科学文献数据库（LILACS）（1982年至2009年5月）以及正在进行的试验数据库；并检查了试验及综述文章的参考文献列表。
我们纳入了所有在围手术期将患者随机分为接受脉搏血氧饱和度测定法或不接受脉搏血氧饱和度测定法的对照试验。
两位作者独立评估了与脉搏血氧饱和度测定法可检测到的事件、麻醉期间或术后发生的任何严重并发症以及术中或术后死亡率相关的数据。
检索共找到五篇报告。我们认为那些涉及总共22992例患者数据且符合分析条件的研究。结果表明，在手术室和恢复室中，脉搏血氧饱和度测定法组的低氧血症情况有所减少。在恢复室观察期间，脉搏血氧饱和度测定法组的低氧血症发生率低1.5至3倍。术后认知功能与围手术期使用脉搏血氧饱和度测定法进行监测无关。普通外科的一项研究表明，血氧饱和度测定法组10%的患者发生了术后并发症，对照组为9.4%。两组在心血管、呼吸、神经或感染性并发症方面未检测到统计学上的显著差异。两组的住院时间中位数均为五天，两组的院内死亡人数相同。持续脉搏血氧饱和度测定法有可能提高心胸外科手术后的警觉性并减少肺部并发症，然而常规持续监测并未减少转入重症监护病房（ICU）的情况或总体死亡率。
这些研究证实脉搏血氧饱和度测定法可检测低氧血症及相关事件。然而，我们未发现证据表明脉搏血氧饱和度测定法会影响患者的麻醉结局。尽管从相对大量的普通外科人群中进行了严格的方法性数据收集，但研究中主观和客观结果相互矛盾，这表明围手术期使用脉搏血氧饱和度测定法进行监测在改善可靠结局、有效性和效率方面的价值值得怀疑。常规持续脉搏血氧饱和度测定法监测既未减少转入ICU的情况，也未降低死亡率，并且尚不清楚在普通护理区域从心胸外科手术中恢复的患者中应用该技术是否有任何实际益处。
