Jiang Qiliang, Kurz Andrea, Zhang Xiaobao, Liu Liu, Yang Dongsheng, Sessler Daniel I
Anesthesiology. 2021 May 1;134(5):709-721. doi: 10.1097/ALN.0000000000003694.
Whether supplemental oxygen worsens long-term mortality remains unclear, with contradictory trial results. The authors therefore tested the hypothesis that supplemental oxygen (80% vs. 30%) increases the hazard for long-term mortality.
The authors conducted a post hoc analysis of a large multiple crossover cluster trial in which more than 5,000 colorectal surgeries on 4,088 adults were allocated to receive either 30% or 80% inspired oxygen during general anesthesia. The authors assessed the effect of 80% versus 30% target-inspired oxygen on long-term mortality and calculated Kaplan-Meier survival estimates. Analysis was restricted to patients with a home address in Ohio because the authors could obtain reliable vital status information from the Ohio Department of Health (Columbus, Ohio) for them.
A total of 3,471 qualifying colorectal surgeries performed in 2,801 patients were analyzed, including 1,753 (51%) surgeries in 1,577 patients given 80% oxygen and 1,718 surgeries in 1,551 patients given 30% oxygen. The observed incidence of death after a median of 3 yr was 13% (234 of 1,753) in the 80% oxygen group and 14% (245 of 1,718) in the 30% oxygen group. The estimated hazard ratio for mortality was 0.94 (95% CI, 0.78 to 1.13; P = 0.493).
In this post hoc analysis of a large, controlled trial, supplemental oxygen did not increase postoperative mortality.
补充氧气是否会增加长期死亡率仍不明确，试验结果相互矛盾。因此，作者检验了补充氧气（80% 与 30%）会增加长期死亡风险的假设。
作者对一项大型多交叉整群试验进行了事后分析，该试验将 4088 名成年人的 5000 多例结直肠手术患者在全身麻醉期间分配接受 30% 或 80% 的吸入氧。作者评估了目标吸入氧 80% 与 30% 对长期死亡率的影响，并计算了 Kaplan-Meier 生存估计值。分析仅限于在俄亥俄州有家庭住址的患者，因为作者可以从俄亥俄州卫生部（俄亥俄州哥伦布市）获得他们可靠的生命状态信息。
共分析了 2801 例患者进行的 3471 例符合条件的结直肠手术，其中 1577 例接受 80% 氧气的患者中有 1753 例（51%）手术，1551 例接受 30% 氧气的患者中有 1718 例手术。在 80% 氧气组中，中位 3 年后观察到的死亡率为 13%（1753 例中的 234 例），在 30% 氧气组中为 14%（1718 例中的 245 例）。死亡率的估计风险比为 0.94（95%CI，0.78 至 1.13；P = 0.493）。
在这项对大型对照试验的事后分析中，补充氧气并未增加术后死亡率。
