使用 STOP-BANG 问卷预测非心脏手术患者术后低氧血症：一项前瞻性队列分析。

Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis.

机构信息

Center for Critical Care Department of Outcomes Research Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

Department of Outcomes Research.

出版信息

Br J Anaesth. 2016 May;116(5):632-40. doi: 10.1093/bja/aew029.

DOI:10.1093/bja/aew029

PMID:27106966

Abstract

BACKGROUND

The STOP-BANG questionnaire is a validated, eight-point dichotomized scale used to screen preoperative patients for obstructive sleep apnoea. Sleep apnoea causes hypoxaemia, and nocturnal oxygen desaturation is diagnostic in these patients. We tested the hypothesis that STOP-BANG score is associated with hypoxaemia after noncardiac surgery.

METHODS

This analysis was a sub-study of VISION, a prospective cohort study of perioperative cardiovascular events. With institutional review board approval, we included 630 patients in the final analysis. We assessed the association between the STOP-BANG score and postoperative hypoxaemia, defined as integrated area under the curve of [Formula: see text] saturation of 90% per h using median quantile regression. Secondarily, we selected a subset of STOP-BANG questions that best predicts postoperative hypoxaemia using 'Least Absolute Shrinkage and Selection Operator' method, and then assessed the association between the new score based on the selected questions and the primary outcome using quantile regression.

RESULTS

The median [q1, q3] area under [Formula: see text] of 90% per h was 0.09 [0.02, 0.39] %-h. The STOP-BANG score was not associated with hypoxaemia, with a multivariable slope coefficient of 0.002 (95% CI: -0.01, 0.01) %-h for a unit increase in the score (P=0.76). Secondarily, no association was found between the new score based on the two retained STOP-BANG questions, treatment for hypertension and neck circumference >40 cm, and the primary outcome with a multivariable slope coefficient of 0.03 (98.3% CI: -0.01, 0.06) %-h/score (P=0.07).

CONCLUSIONS

The STOP-BANG score does not predict hypoxaemia in adults recovering from noncardiac surgery.

CLINICAL TRIAL REGISTRATION

NCT00512109.

摘要

背景

STOP-BANG 问卷是一种经过验证的、八点二分制量表，用于筛查术前患者是否患有阻塞性睡眠呼吸暂停。睡眠呼吸暂停会导致低氧血症，而夜间血氧饱和度下降是这些患者的诊断标准。我们验证了这样一个假设，即 STOP-BANG 评分与非心脏手术后的低氧血症有关。

方法

本分析是一项前瞻性心血管事件围手术期研究 VISION 的子研究。经过机构审查委员会批准，我们最终分析纳入了 630 名患者。我们使用中位数分位数回归评估了 STOP-BANG 评分与术后低氧血症之间的关系，术后低氧血症定义为[Formula: see text]饱和度的积分曲线下面积每小时 90%的中位数[Formula: see text]。其次，我们使用“最小绝对收缩和选择算子”方法选择了一组最佳预测术后低氧血症的 STOP-BANG 问题，然后使用分位数回归评估基于所选问题的新评分与主要结局之间的关系。

结果

[Formula: see text]饱和度 90%的中位数[q1, q3]每小时的曲线下面积为 0.09 [0.02, 0.39] %-h。STOP-BANG 评分与低氧血症无关，评分每增加一个单位，多变量斜率系数为 0.002（95%CI：-0.01, 0.01）%-h（P=0.76）。其次，基于两个保留的 STOP-BANG 问题（高血压治疗和颈围>40cm）的新评分与主要结局之间也没有关联，多变量斜率系数为 0.03（98.3%CI：-0.01, 0.06）%-h/评分（P=0.07）。