Zhang Furong, Zhang Ruqiang, He Liang, Yin Jianwei, Wang Fang, Li Junmin
Department of Anesthesiology Department of Orthopedics, Yan'an Hospital of Kunming City, Kunming Medical University, Kunming, China.
Medicine (Baltimore). 2017 Apr;96(15):e6587. doi: 10.1097/MD.0000000000006587.
The partial pressure of oxygen decreases as altitude increases, the preoperative chronic hypoxemia (CH) may have a plausible clinical impact. Risk factors for postoperative serious adverse events (pSAEs) in patients living in high altitudes during primary hip arthroplasty (HA) are not clear.This is an observational study embracing patients from January 1, 2011 to December 31, 2015 at Yan'an Hospital of Kunming City, a 1338-bed municipal teaching hospital of Kunming Medical University. Univariate analysis revealed that significant differences between patients with and without preoperative CH occurred in intraoperative hypotension (77 [33%] vs 34 [47%], P = .040) and that significant differences between patients with and without pSAEs occurred in following variables: preoperative CH (32 [57%] vs 199 [80%], P < .001), intraoperative hypotension (37 [66%] vs 74 [30%], P < .001), highest noradrenaline support (.09 [.01-.21] vs .03 [.01-.05] μg/kg/min, P < .001), higher application of general anesthesia (15 [27%] vs 29 [12%], P = .004), and lower of combined-spinal epidural anesthesia (CSEA) (21 [37%] vs 165 [66%], P < .001). The general anesthesia and intraoperative hypotension remained the independent risk factors for pSAEs (P < .05), while the preoperative CH presented by decreasing its risk (P < .05).This study suggests that various intraoperative events including general anesthesia, hypotension were risk factors for the development of pSAEs. Preoperative CH, presenting with decreased incidence of intensive care unit (ICU) admission and pSAEs, may mimic hypoxic preconditioning in organic protection, for which further study is needed to uncover the underlying mechanisms.
随着海拔升高，氧分压降低，术前慢性低氧血症（CH）可能会产生合理的临床影响。在初次髋关节置换术（HA）期间，生活在高海拔地区的患者术后严重不良事件（pSAEs）的风险因素尚不清楚。这是一项观察性研究，纳入了2011年1月1日至2015年12月31日期间在昆明市延安医院就诊的患者，该医院是昆明医科大学的一家拥有1338张床位的市级教学医院。单因素分析显示，术前有CH和无CH的患者在术中低血压方面存在显著差异（77例[33%]对34例[47%]，P = 0.040），有pSAEs和无pSAEs的患者在以下变量方面存在显著差异：术前CH（32例[57%]对199例[80%]，P < 0.001）、术中低血压（37例[66%]对74例[30%]，P < 0.001）、最高去甲肾上腺素支持量（0.09[0.01 - 0.21]对0.03[0.01 - 0.05]μg/kg/min，P < 0.001）、全身麻醉的更高应用率（15例[27%]对29例[12%]，P = 0.004）以及腰麻 - 硬膜外联合麻醉（CSEA）的更低应用率（21例[37%]对165例[66%]，P < 0.001）。全身麻醉和术中低血压仍然是pSAEs的独立危险因素（P < 0.05），而术前CH通过降低其风险呈现出来（P < 0.05）。本研究表明，包括全身麻醉、低血压在内的各种术中事件是pSAEs发生的危险因素。术前CH表现为重症监护病房（ICU）入住率和pSAEs发生率降低，可能在器官保护方面模拟了缺氧预处理，对此需要进一步研究以揭示其潜在机制。
