Balzer Felix, Sander Michael, Simon Mark, Spies Claudia, Habicher Marit, Treskatsch Sascha, Mezger Viktor, Schirmer Uwe, Heringlake Matthias, Wernecke Klaus-Dieter, Grubitzsch Herko, von Heymann Christian
Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Campus Charité Mitte/Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
Crit Care. 2015 Apr 16;19(1):168. doi: 10.1186/s13054-015-0889-6.
Central venous saturation (ScvO2) monitoring has been suggested to address the issue of adequate cardiocirculatory function in the context of cardiac surgery. The aim of this study was to determine the impact of low (L) (<60%), normal (N) (60%-80%), and high (H) (>80%) ScvO2 measured on intensive care unit (ICU) admission after cardiac surgery.
We conducted a retrospective, cross-sectional, observational study at three ICUs of a university hospital department for anaesthesiology and intensive care. Electronic patient records of all adults who underwent cardiac surgery between 2006 and 2013 and available admission measurements of ScvO2 were examined. Patients were allocated to one of three groups according to first ScvO2 measurement after ICU admission: group L (<60%), group N (60%-80%), and group H (>80%). Primary end-points were in-hospital and 3-year follow-up survival.
Data from 4,447 patients were included in analysis. Low and high initial measurements of ScvO2 were associated with increased in-hospital mortality (L: 5.6%; N: 3.3%; H: 6.8%), 3-year follow-up mortality (L: 21.6%; N: 19.3%; H: 25.8%), incidence of post-operative haemodialysis (L: 11.5%; N: 7.8%; H: 15.3%), and prolonged hospital length of stay (L: 13 days, 9-22; N: 12 days, 9-19; H: 14 days, 9-21). After adjustment for possible confounding variables, an initial ScvO2 above 80% was associated with adjusted hazard ratios of 2.79 (95% confidence interval (CI) 1.565-4.964, P <0.001) for in-hospital survival and 1.31 (95% CI 1.033-1.672, P = 0.026) for 3-year follow-up survival.
Patients with high ScvO2 were particularly affected by unfavourable outcomes. Advanced haemodynamic monitoring may help to identify patients with high ScvO2 who developed extraction dysfunction and to establish treatment algorithms to improve patient outcome in these patients.
有人建议通过监测中心静脉血氧饱和度（ScvO2）来解决心脏手术中心脏循环功能是否充足的问题。本研究的目的是确定心脏手术后入住重症监护病房（ICU）时测得的低（L）（<60%）、正常（N）（60%-80%）和高（H）（>80%）ScvO2水平的影响。
我们在一所大学医院麻醉与重症监护科的三个ICU进行了一项回顾性横断面观察研究。检查了2006年至2013年间接受心脏手术的所有成年人的电子病历以及可获得的入院时ScvO2测量值。根据入住ICU后首次ScvO2测量值，将患者分为三组：L组（<60%）、N组（60%-80%）和H组（>80%）。主要终点是住院期间和3年随访期的生存率。
4447例患者的数据纳入分析。ScvO2初始测量值低和高与住院死亡率增加（L组：5.6%；N组：3.3%；H组：6.8%）、3年随访死亡率（L组：21.6%；N组：19.3%；H组：25.8%）、术后血液透析发生率（L组：11.5%；N组：7.8%；H组：15.3%）以及住院时间延长（L组：13天，9-22天；N组：12天，9-19天；H组：14天，9-21天）相关。在对可能的混杂变量进行调整后，初始ScvO2高于80%与住院生存率的调整后风险比为2.79（95%置信区间（CI）1.565-4.964，P<0.001）以及3年随访生存率的调整后风险比为1.31（95%CI 1.033-1.672，P = 0.026）相关。
ScvO2高的患者受不良结局影响尤为明显。先进的血流动力学监测可能有助于识别发生提取功能障碍的ScvO2高的患者，并建立治疗算法以改善这些患者的预后。
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