中高危腹部大手术患者围手术期补充氧气与氧化应激——一项随机临床试验的亚组分析

Perioperative supplemental oxygen and oxidative stress in patients undergoing moderate- to high-risk major abdominal surgery - A subanalysis of randomized clinical trial.

作者信息

Reiterer Christian, Fleischmann Edith, Taschner Alexander, Adamowitsch Nikolas, von Sonnenburg Markus Falkner, Graf Alexandra, Fraunschiel Melanie, Starlinger Patrick, Goschin Julius, Kabon Barbara

机构信息

Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria; Outcomes Research Consortium, Cleveland, OH, USA.

出版信息

J Clin Anesth. 2022 May;77:110614. doi: 10.1016/j.jclinane.2021.110614. Epub 2021 Nov 29.

DOI:10.1016/j.jclinane.2021.110614

PMID:34856530

Abstract

STUDY OBJECTIVE

Oxidative stress plays a pivotal role in the development and aggravation of cardiovascular diseases. The influence of intraoperative inspired oxygen concentrations on oxidative stress is still not entirely known. Therefore, we evaluated in this sub-study if supplemental oxygen affects the oxidation-reduction potential in patients at-risk for cardiovascular complications undergoing moderate- to high-risk major abdominal surgery.

DESIGN

Sub-study of a prospective parallel-arm double-blinded single-center superiority randomized trial.

SETTING

Operating room and postoperative recovery area.

INTERVENTION

Administration of 0.8 FiO versus 0.3 FiO throughout surgery and for the first two postoperative hours.

MEASUREMENTS

The primary outcome was the static oxidation-reduction potential (sORP) and the oxidation-reduction potential capacity (cORP) between both groups. The secondary outcome was the trend of sORP and cORP in the overall study population. We assessed sORP and cORP before induction of anesthesia, 2 h after induction of anesthesia, within 2 h after surgery and on the first and third postoperative day.

MAIN RESULTS

258 patients were analyzed. 128 patients were randomly assigned to the 80% oxygen group and 130 patients were randomly assigned to the 30% oxygen group. Postoperative sORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -1.162 mV,95% CI: -2.584 to 0.260; p = 0.109). On average, we observed a change in sORP of 5.288 mV (95% CI:4.633 to 5.913, p < 0.001) per day. cORP values did not differ significantly between the 80% and 30% oxygen group (effect estimate: -0.015μC, (95%CI: -0.062 to 0.032; p = 0.524). On average, we observed a change in cORP values of -0.170μC (95%CI: -0.194 to -0.147, p < 0.001) per day.

CONCLUSION

In contrast to previous reports, we could not find any evidence of an association between intraoperative supplemental oxygen and perioperative oxidative stress assessed by sORP and cORP.

TRIAL REGISTRATION

clinicaltrials.gov: NCT03366857https://clinicaltrials.gov/ct2/show/NCT03366857?term=vienna&cond=oxygen&draw=2&rank=1.

摘要

研究目的

氧化应激在心血管疾病的发生和加重过程中起关键作用。术中吸入氧浓度对氧化应激的影响尚不完全清楚。因此，在本亚组研究中，我们评估了补充氧气是否会影响接受中高危腹部大手术的心血管并发症高危患者的氧化还原电位。

设计

一项前瞻性平行组双盲单中心优效性随机试验的亚组研究。

地点

手术室和术后恢复区。

干预措施

在整个手术过程及术后前两小时给予0.8的吸入氧分数（FiO）与0.3的吸入氧分数。

测量指标

主要结局是两组之间的静态氧化还原电位（sORP）和氧化还原电位容量（cORP）。次要结局是整个研究人群中sORP和cORP的变化趋势。我们在麻醉诱导前、麻醉诱导后2小时、术后2小时内以及术后第一天和第三天评估sORP和cORP。

主要结果

分析了258例患者。128例患者被随机分配至80%氧组，130例患者被随机分配至30%氧组。80%氧组和30%氧组术后sORP值无显著差异（效应估计值：- 1.162mV，95%置信区间：- 2.584至0.260；p = 0.109）。平均而言，我们观察到sORP每天变化5.288mV（95%置信区间：4.633至5.913，p < 0.001）。80%氧组和30%氧组cORP值无显著差异（效应估计值：- 0.015μC，95%置信区间：- 0.062至0.032；p = 0.524）。平均而言，我们观察到cORP值每天变化- 0.170μC（95%置信区间：- 0.194至- 0.147，p < 0.001）。