Suehiro Koichi, Tanaka Katsuaki, Matsuura Tadashi, Funao Tomoharu, Yamada Tokuhiro, Mori Takashi, Nishikawa Kiyonobu
Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
J Cardiothorac Vasc Anesth. 2014 Jun;28(3):528-33. doi: 10.1053/j.jvca.2013.03.002. Epub 2013 Aug 22.
To determine if increases in discrepancy between ScvO2 and SvO2 (ScvO2 - SvO2 = ΔSO2) during surgery in cardiac surgery patients can predict postoperative complications.
Prospective, observational study.
University hospital.
One hundred two patients undergoing cardiac surgery were enrolled.
None.
Central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) values during surgery automatically were collected. The average value of ΔSO2 for every minute was calculated. The area under the receiver operating characteristic curve for prolonged postoperative ICU stay (≥3 days) was 0.745 for ΔSO2, which was significantly different from those of ScvO2 and SvO2 (p<0.05) (ScvO2; 0.584, SvO2; 0.598). The optimal threshold value of ΔSO2 to predict prolonged ICU stay (≥3 days) was 12% (sensitivity: 72.0%, specificity: 76.9%). Postoperative ICU duration, ventilation time, and hospital stay were significantly longer in Group D patients (intraoperative maximum ΔSO2 ≥12%) than those in Group N patients (intraoperative maximum ΔSO2<12%). As for postoperative complications, the number of patients with postoperative use of intra-aortic balloon pumping, delirium, respiratory failure requiring tracheotomy, and severe complications was significantly higher in Group D patients. Multivariate logistic regression models were used to evaluate the independent effects of perioperative variables on the risk of developing prolonged ventilation (>24 hours) and prolonged ICU stay (≥3 days). A discrepancy in intraoperative ΔSO2 was an independent risk factor for prolonged postoperative ventilation and ICU stay.
The discrepancy between ScvO2 and SvO2 during cardiac surgery is an independent risk factor of postoperative complications such as prolonged ICU stay and ventilation time.
确定心脏手术患者术中中心静脉血氧饱和度（ScvO2）与混合静脉血氧饱和度（SvO2）之间的差值增加（ScvO2 - SvO2 = ΔSO2）是否可预测术后并发症。
前瞻性观察性研究。
大学医院。
纳入102例行心脏手术的患者。
无。
术中自动收集中心静脉血氧饱和度（ScvO2）和混合静脉血氧饱和度（SvO2）值。计算每分钟ΔSO2的平均值。术后入住重症监护病房（ICU）时间延长（≥3天）的受试者工作特征曲线下面积，ΔSO2为0.745，与ScvO2和SvO2的曲线下面积显著不同（p<0.05）（ScvO2为0.584，SvO2为0.598）。预测ICU入住时间延长（≥3天）的ΔSO2最佳阈值为12%（敏感性：72.0%，特异性：76.9%）。D组患者（术中最大ΔSO2≥12%）术后ICU住院时间、通气时间和住院时间显著长于N组患者（术中最大ΔSO2<12%）。至于术后并发症，D组患者术后使用主动脉内球囊反搏、谵妄、需要气管切开的呼吸衰竭及严重并发症的患者数量显著更多。采用多因素逻辑回归模型评估围手术期变量对发生长时间通气（>24小时）和ICU入住时间延长（≥3天）风险的独立影响。术中ΔSO2差异是术后长时间通气和ICU入住时间延长的独立危险因素。
心脏手术期间ScvO2与SvO2之间的差异是术后并发症（如ICU入住时间延长和通气时间延长）的独立危险因素。
