术中高吸氧分数对儿童手术术后恶心呕吐的影响：一项前瞻性随机双盲研究。

Effect of intra-operative high inspired fraction of oxygen on postoperative nausea and vomiting in children undergoing surgery: A prospective randomised double-blind study.

机构信息

From the Department of Anesthesiology & Critical Care (BKB, SM), Department of Pediatric Surgery (MKM) and Department of Pharmacology (AS), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Orissa, India.

出版信息

Eur J Anaesthesiol. 2021 Nov 1;38(11):1124-1129. doi: 10.1097/EJA.0000000000001577.

DOI:10.1097/EJA.0000000000001577

PMID:34313610

Abstract

BACKGROUND

Administration of high inspired fraction of oxygen (FiO2) during anaesthesia has been proposed to decrease postoperative nausea and vomiting (PONV) in adults but has not been extensively studied in children.

OBJECTIVES

The primary objective of this study was to evaluate the effect of 80% FiO2 on the incidence of PONV in children undergoing surgery.

DESIGN

Prospective, randomised, study.

SETTING

Single-centre, teaching hospital.

PATIENTS

Children of either gender in the age group of 5 to 15 years scheduled for elective surgeries were assessed for eligibility. Emergency surgeries; patients receiving supplemental oxygen pre-operatively or on mechanical ventilation; sepsis; bowel obstruction or ischaemia; poor nutritional status; anaemia (Hb <8 g%) or surgeries lasting less than 1 h or greater than 4 h were excluded from the study.

INTERVENTIONS

After induction of anaesthesia, children were randomised to receive either 30 or 80% oxygen in air, till the end of surgery.

MAIN OUTCOME MEASURES

Incidence of PONV within 24 h; surgical site infections (SSI)s; serum serotonin and TNF-α levels and the incidence of postoperative pulmonary complications (PPC)s were studied.

RESULTS

The overall 24 h incidence of PONV was not different between the low and high FiO2 groups [24 vs. 23%; P = 0.84; odds ratio (OR) 0.92; 95% confidence interval (CI), 0.44 to 2.06]. The incidence of SSIs (15 vs. 12%; P = 0.61; OR 0.77; 95% CI, 0.28 to 2.10) and PPCs (12 vs. 8%; P = 0.38; OR 0.59; 95% CI, 0.18 to 1.92) were not significant between the low and high FiO2 groups, respectively. Intragroup and intergroup comparisons of serum serotonin and TNF-α showed no significant difference either at baseline or at the end of surgery.

CONCLUSION

High intra-operative FiO2 of 80% does not provide additional protection against PONV in children.

TRIAL REGISTRATION

The study was registered with Clinical Trials Registry of India (CTRI) with trial registration no: CTRI/2018/07/014974.

摘要

背景

在麻醉期间给予高吸入氧分数（FiO2）已被提议用于减少成人术后恶心和呕吐（PONV），但在儿童中尚未广泛研究。

目的

本研究的主要目的是评估 80%FiO2 对接受手术的儿童 PONV 发生率的影响。

设计

前瞻性、随机研究。

地点

单中心、教学医院。

患者

年龄在 5 至 15 岁的接受择期手术的男女儿童均进行了资格评估。急诊手术；术前或机械通气时接受补充氧气的患者；脓毒症；肠梗阻或缺血；营养状况差；贫血（Hb<8g%）或手术时间少于 1 小时或超过 4 小时的患者被排除在研究之外。

干预

麻醉诱导后，儿童随机接受 30%或 80%空气中的氧气，直至手术结束。

主要观察结果

24 小时内 PONV 的发生率；手术部位感染（SSI）；血清 5-羟色胺和 TNF-α水平以及术后肺部并发症（PPC）的发生率。

结果

低 FiO2 和高 FiO2 组 24 小时内 PONV 的总发生率无差异[24%与 23%；P=0.84；优势比（OR）0.92；95%置信区间（CI）0.44 至 2.06]。SSI 的发生率（15%与 12%；P=0.61；OR 0.77；95%CI，0.28 至 2.10）和 PPC 的发生率（12%与 8%；P=0.38；OR 0.59；95%CI，0.18 至 1.92）在低 FiO2 和高 FiO2 组之间均无显著差异。血清 5-羟色胺和 TNF-α 的组内和组间比较在基线或手术结束时均无显著差异。