Department of Anaesthesiology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
Curr Opin Anaesthesiol. 2019 Dec;32(6):783-791. doi: 10.1097/ACO.0000000000000791.
The topic of perioperative hyperoxia remains controversial, with valid arguments on both the 'pro' and 'con' side. On the 'pro' side, the prevention of surgical site infections was a strong argument, leading to the recommendation of the use of hyperoxia in the guidelines of the Center for Disease Control and the WHO. On the 'con' side, the pathophysiology of hyperoxia has increasingly been acknowledged, in particular the pulmonary side effects and aggravation of ischaemia/reperfusion injuries.
Some 'pro' articles leading to the Center for Disease Control and WHO guidelines advocating perioperative hyperoxia have been retracted, and the recommendations were downgraded from 'strong' to 'conditional'. At the same time, evidence that supports a tailored, more restrictive use of oxygen, for example, in patients with myocardial infarction or following cardiac arrest, is accumulating.
The change in recommendation exemplifies that despite much work performed on the field of hyperoxia recently, evidence on either side of the argument remains weak. Outcome-based research is needed for reaching a definite recommendation.
围手术期高氧的话题仍然存在争议，“赞成”和“反对”双方都有合理的观点。从“赞成”的角度来看，预防手术部位感染是一个强有力的论据，这导致了疾病控制中心和世界卫生组织建议在围手术期使用高氧。从“反对”的角度来看，高氧的病理生理学越来越被认可，特别是肺部的副作用和加重缺血/再灌注损伤。
一些导致疾病控制中心和世界卫生组织建议围手术期高氧的“赞成”文章被撤回，建议从“强烈”降级为“有条件”。与此同时，越来越多的证据支持更有针对性、更严格的氧气使用，例如在心肌梗死或心脏骤停后的患者中。
建议的改变说明了尽管最近在高氧领域做了大量的工作，但争论双方的证据仍然薄弱。需要基于结果的研究来做出明确的建议。
