术中基础氧耗作为急诊开腹手术预后因素的研究

Intraoperative baseline oxygen consumption as a prognostic factor in emergency open abdominal surgery.

作者信息

Masuda Toshiro, Kuramoto Masafumi, Tanimoto Hironari, Yamamoto Kenichiro, Ikeshima Satoshi, Kitano Yuuki, Kuroda Daisuke, Shimada Shinya, Baba Hideo

机构信息

Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Yatsushiro, Kumamoto, Japan; Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan.

Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Yatsushiro, Kumamoto, Japan.

出版信息

J Crit Care. 2016 Apr;32:42-7. doi: 10.1016/j.jcrc.2015.11.014. Epub 2015 Nov 26.

DOI:10.1016/j.jcrc.2015.11.014

PMID:26810484

Abstract

BACKGROUND

A new anesthesia system, the E-CAIOVX (GE Healthcare) enables the continuous monitoring of oxygen consumption (VO2) and carbon dioxide elimination (VCO2) during the surgical operation. The aim of this study was to evaluate the prognostic role of intraoperative baseline VO2 and VCO2 in an emergency open abdominal operation.

METHODS

A total of 103 patients who had an emergency open abdominal operation were enrolled in the study. VO2 and VCO2 were continuously measured from the induction of anesthesia to the end of the operation.

RESULTS

There were significant correlations between intraoperative baseline VO2 and body surface area (BSA; P < .001, r = 0.68), VO2 and tidal volume (P < .001, r = 0.59), and VO2 and baseline body temperature (P < .0001, r = 0.49). Also, there were significant correlations between intraoperative baseline VCO2 and BSA (P < .001, r = 0.70), VCO2 and tidal volume (P < .001, r = 0.70), and VCO2 and body temperature (P < .001, r = 0.41). Fifteen (14.6%) of the 103 patients died within 4 months after the operation without having been discharged from hospital. Baseline VO2/BSA was higher in surviving patients (123.7 ± 23.6 mL/min ∙ m(2)) than the deceased (103.8 ± 15.6 mL/min ∙ m(2); P = .002). There was no significant difference in baseline VCO2/BSA levels between surviving (106.2 ± 20.1 mL/min ∙ m(2)) and deceased patients (99.4 ± 21.4 mL/min ∙ m(2)). In multivariate analysis, baseline body temperature lower than 36.2°C (P = .02), serum albumin less than 3.0 g/dL (P = .002), and baseline VO2/BSA less than 111.9 mL/min ∙ m(2) (P = .03) were independent factors.

CONCLUSION

Baseline low VO2/BSA less than 111.9 mL/min ∙ m(2) was one of the poor predictors for the prognosis of an emergency open abdominal surgery.

摘要

背景

一种新型麻醉系统E-CAIOVX（通用电气医疗集团）能够在外科手术过程中持续监测氧耗量（VO2）和二氧化碳排出量（VCO2）。本研究旨在评估术中基础VO2和VCO2在急诊开腹手术中的预后作用。

方法

本研究共纳入103例行急诊开腹手术的患者。从麻醉诱导至手术结束持续测量VO2和VCO2。

结果

术中基础VO2与体表面积（BSA；P <.001，r = 0.68）、VO2与潮气量（P <.001，r = 0.59）以及VO2与基础体温（P <.0001，r = 0.49）之间存在显著相关性。此外，术中基础VCO2与BSA（P <.001，r = 0.70）、VCO2与潮气量（P <.001，r = 0.70）以及VCO2与体温（P <.001，r = 0.41）之间也存在显著相关性。103例患者中有15例（14.6%）在术后4个月内未出院死亡。存活患者的基础VO2/BSA（123.7±23.6 mL/min∙m²）高于死亡患者（103.8±15.6 mL/min∙m²；P =.002）。存活患者（106.2±20.1 mL/min∙m²）和死亡患者（99.4±21.4 mL/min∙m²）的基础VCO2/BSA水平无显著差异。多因素分析显示，基础体温低于36.2°C（P =.02）、血清白蛋白低于3.0 g/dL（P =.002）以及基础VO2/BSA低于111.9 mL/min∙m²（P =.03）是独立因素。