Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
Obes Surg. 2010 Jul;20(7):885-94. doi: 10.1007/s11695-010-0168-1.
Subcutaneous tissue oxygen tension (PsqO(2)) is a major predictor for wound healing and the occurrence of wound infections. Perioperative subcutaneous wound and tissue oxygen tension is significantly reduced in morbidly obese patients. Even during intraoperative supplemental oxygen administration, PsqO(2) remains low. Tissue hypoxia is pronounced during surgery and might explain the substantial increase in infection risk in obese patients. It remains unknown whether long-term supplemental postoperative oxygen augments tissue oxygen tension. Consequently, we tested the hypothesis that 80% inspired oxygen administration during 12-18 postoperative hours significantly increases PsqO(2) compared to 30% inspired oxygen fraction.
After IRB approval and informed consent, 42 patients undergoing laparoscopic bariatric surgery were randomly assigned to receive either 80% inspired oxygen via a PULMANEX Hi-Ox Mask (Viasys MedSystems, Wheeling, IL) (10 L/min) or 30% oxygen via nasal cannula (2 L/min) after surgery until the next morning. PsqO(2) was measured with a temperature-corrected Clark-type electrode in the subcutaneous tissue of the upper arm and adjacent to the wound.
Postoperative subcutaneous tissue oxygen tension was significantly increased in the Hi-Ox group: 58 (47.7, 74.1) mmHg vs. 43 (38.7, 55.2) mmHg, P = 0.002. Also, wound tissue oxygen tension was improved during supplemental oxygen administration: 75.2 (69.8, 95.5) mmHg vs. 52.4 (46.3, 66.1) mmHg, P < 0.001.
Subcutaneous tissue oxygen tension was significantly increased by supplemental postoperative oxygen administration. Whether there is an effect on the incidence of wound infection in morbidly obese patients is matter of further research.
皮下组织氧张力（PsqO2）是伤口愈合和发生伤口感染的主要预测指标。病态肥胖患者围手术期皮下伤口和组织氧张力显著降低。即使在术中补充吸氧时，PsqO2 仍然较低。手术期间组织缺氧明显，这可能解释了肥胖患者感染风险的大幅增加。尚不清楚术后长期补充氧气是否会增加组织氧张力。因此，我们检验了以下假设，即在术后 12-18 小时内给予 80%的吸入氧分压（FiO2）通过 PULMANEX Hi-Ox 面罩（Viasys MedSystems，Wheeling，IL）（10 L/min）与给予 30%的 FiO2 通过鼻导管（2 L/min）相比，显著增加 PsqO2。
在获得机构审查委员会批准和知情同意后，42 例行腹腔镜减重手术的患者被随机分为两组，术后分别接受 80%的 FiO2 通过 PULMANEX Hi-Ox 面罩（Viasys MedSystems，Wheeling，IL）（10 L/min）或 30%的 FiO2 通过鼻导管（2 L/min）吸氧，直至次日早晨。PsqO2 通过在上臂皮下组织和伤口附近使用经温度校正的Clark 型电极进行测量。
Hi-Ox 组术后皮下组织氧张力显著升高：58（47.7，74.1）mmHg 与 43（38.7，55.2）mmHg，P=0.002。此外，在补充氧疗期间，伤口组织氧张力也得到改善：75.2（69.8，95.5）mmHg 与 52.4（46.3，66.1）mmHg，P<0.001。
术后补充氧气可显著增加皮下组织氧张力。补充氧气是否会对病态肥胖患者的伤口感染发生率产生影响，尚需进一步研究。
