Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Anesth Analg. 2012 Oct;115(4):849-54. doi: 10.1213/ANE.0b013e3182652a51. Epub 2012 Jul 13.
A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen. In this follow-up study of the PROXI trial we assessed the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery.
From October 8, 2006, to October 6, 2008, 1386 patients underwent elective or emergency laparotomy and were randomized to receive either 80% or 30% oxygen during and for 2 hours after surgery. The follow-up date was February 24, 2010. Survival was analyzed using Kaplan-Meier statistics and the Cox proportional hazards model.
Vital status was obtained in 1382 of 1386 patients after a median follow-up of 2.3 years (range 1.3 to 3.4 years). One hundred fifty-nine of 685 patients (23.2%) died in the 80% oxygen group compared to 128 of 701 patients (18.3%) assigned to 30% oxygen (HR, 1.30 [95% confidence interval, 1.03 to 1.64], P = 0.03). In patients undergoing cancer surgery, the HR was 1.45; 95% confidence interval, 1.10 to 1.90; P = 0.009; and after noncancer surgery, the HR was 1.06; 95% confidence interval, 0.69 to 1.65; P = 0.79.
Administration of 80% oxygen in the perioperative period was associated with significantly increased long-term mortality and this appeared to be statistically significant in patients undergoing cancer surgery but not in noncancer patients.
高围手术期吸入氧分数（80%）已被推荐用于预防术后伤口感染。然而，最近规模最大的试验之一 PROXI 试验发现，使用 80%氧气并不能降低手术部位感染率，并且给予 80%氧气的患者 30 天死亡率更高。在 PROXI 试验的这项随访研究中，我们评估了接受腹部手术的患者围手术期氧分数与长期死亡率之间的关系。
从 2006 年 10 月 8 日至 2008 年 10 月 6 日，1386 名患者接受了择期或急诊剖腹术，并随机分为在手术期间和手术后 2 小时内接受 80%或 30%氧气的两组。随访日期为 2010 年 2 月 24 日。使用 Kaplan-Meier 统计和 Cox 比例风险模型分析生存情况。
在中位随访 2.3 年（范围 1.3 至 3.4 年）后，1386 名患者中的 1382 名获得了生存状态。在 80%氧气组中，685 名患者中有 159 名（23.2%）死亡，而在接受 30%氧气的 701 名患者中，有 128 名（18.3%）死亡（风险比，1.30 [95%置信区间，1.03 至 1.64]，P = 0.03）。在接受癌症手术的患者中，风险比为 1.45；95%置信区间，1.10 至 1.90；P = 0.009；而在非癌症手术患者中，风险比为 1.06；95%置信区间，0.69 至 1.65；P = 0.79。
围手术期给予 80%氧气与长期死亡率显著增加相关，在接受癌症手术的患者中这种相关性具有统计学意义，但在非癌症患者中则没有。
