Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Anesthesiology. 2011 Jun;114(6):1313-9. doi: 10.1097/ALN.0b013e31821bdb82.
Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy.
This study was a planned analysis of the obese patients (body mass index ≥ 30 kg/m²) recruited in the Danish multicenter, patient- and observer-blinded, PROXI Trial of 1,400 patients undergoing acute or elective laparotomy. Patients were randomized to receive either 80% or 30% oxygen during and for 2 h after surgery. The primary outcome was SSI within 14 days. Secondary outcomes were atelectasis, pneumonia, and respiratory failure.
Two hundred thirteen patients had a body mass index ≥ 30 kg/m². The median (5-95% range) body mass index was 34 kg/m² (30-44) and 33 kg/m² (30-41) in patients allocated to the 80% and 30% oxygen group. SSI occurred in 32 of 102 (31%) versus 29 of 111 (26%) patients given 80% and 30% oxygen, respectively (odds ratio, 1.29; 95% CI, 0.71-2.34; P = 0.40). In addition, the incidence of pulmonary complications was not significantly different, with atelectasis occurring in 9% versus 6%, pneumonia in 6% versus 5%, and respiratory failure in 8% versus 5% in patients given 80% and 30% oxygen, respectively.
Administration of 80% oxygen, compared with 30% oxygen, did not reduce the frequency of SSI in obese patients. Moreover, no significant association was found between oxygen fraction and the risk of pulmonary complications.
肥胖患者术后并发症风险较高，包括手术部位感染（SSI）。我们的目的是评估高吸入氧分数（80%）对肥胖患者行剖腹手术后 SSI 和肺部并发症的影响。
这是一项针对丹麦多中心、患者和观察者双盲、PROXI 试验中 1400 例接受急症或择期剖腹手术的肥胖患者（BMI≥30kg/m²）的计划分析。患者随机接受 80%或 30%氧气，在手术中和手术后 2 小时内给予。主要结局为术后 14 天内 SSI。次要结局为肺不张、肺炎和呼吸衰竭。
213 例患者 BMI≥30kg/m²。80%和 30%氧气组患者的 BMI 中位数（5-95%范围）分别为 34kg/m²（30-44）和 33kg/m²（30-41）。80%和 30%氧气组分别有 32 例（31%）和 29 例（26%）患者发生 SSI（优势比，1.29；95%CI，0.71-2.34；P=0.40）。此外，肺部并发症的发生率也无显著差异，肺不张发生率分别为 9%和 6%，肺炎发生率分别为 6%和 5%，呼吸衰竭发生率分别为 8%和 5%。
与 30%氧气相比，给予肥胖患者 80%氧气并不能降低 SSI 的发生频率。此外，氧分数与肺部并发症风险之间也没有显著关联。
