[术后入住重症监护病房患者低氧血症的危险因素]
[Risk factors of hypoxemia in patients admitted to intensive care unit after surgery].
作者信息
Li Xunliang, Chen Man, Wang Chunting, Zhang Jicheng
机构信息
Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China.
Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China. Corresponding author: Zhang Jicheng, Email:
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Feb;34(2):161-166. doi: 10.3760/cma.j.cn121430-20211118-01747.
OBJECTIVE
To investigate the risk factors of postoperative hypoxemia in patients admitted to intensive care unit (ICU) for resuscitation.
METHODS
Clinical data of 220 postoperative patients admitted to the ICU for resuscitation in Shandong Provincial Hospital Affiliated to Shandong University from June to August 2020 were collected and retrospectively analyzed. According to their oxygenation index within 30 minutes after admission to ICU, they were divided into hypoxemia group (oxygenation index ≤ 300 mmHg, 1 mmHg ≈ 0.133 kPa) and non-hypoxemia group (oxygenation index > 300 mmHg). Baseline data and perioperative indicators were compared between the two groups, and risk factors for early postoperative hypoxemia were analyzed. The improvement of oxygenation index of patients with hypoxemia in next morning after admission to ICU was observed, and the factors related to the improvement of hypoxemia were analyzed.
RESULTS
The incidence of hypoxemia was 36.8% (81/220) in the cohort. The majority cases of hypoxemia were from general surgery department, accounting for 42.0% (34/81). The incidence rate of hypoxemia from orthopaedic was the highest at 53.3% (16/30). Univariate analysis showed that body mass index (BMI), intraoperative hypoxemia, minimally invasive surgery were all risk factors of postoperative hypoxemia (test values were -2.566, 12.352 and 0.033; P values were 0.010, 0.000 and 0.019, respectively). Multivariate analysis showed that intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia [intraoperative hypoxemia: odds ratio (OR) = 3.602, 95% confidence interval (95%CI) was 1.143-3.817, P = 0.001; BMI: OR = 1.119, 95%CI was 1.026-1.208, P = 0.036]. The improvement rate of hypoxemia next morning after admission to ICU was 63.0% (51/81). Pulmonary dysfunction was the independent risk factor for the improvement of hypoxemia (OR = 0.200, 95%CI was 0.052-0.763, P = 0.019).
CONCLUSIONS
Hypoxemia might occur early after surgery. Intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia.
目的
探讨入住重症监护病房（ICU）进行复苏的患者术后低氧血症的危险因素。
方法
收集山东大学附属山东省立医院2020年6月至8月入住ICU进行复苏的220例术后患者的临床资料，并进行回顾性分析。根据入住ICU后30分钟内的氧合指数，将其分为低氧血症组（氧合指数≤300 mmHg，1 mmHg≈0.133 kPa）和非低氧血症组（氧合指数>300 mmHg）。比较两组的基线数据和围手术期指标，分析术后早期低氧血症的危险因素。观察入住ICU后次日清晨低氧血症患者氧合指数的改善情况，并分析与低氧血症改善相关的因素。
结果
该队列中低氧血症的发生率为36.8%（81/220）。低氧血症的大多数病例来自普通外科，占42.0%（34/81）。骨科低氧血症的发生率最高，为53.3%（16/30）。单因素分析显示，体重指数（BMI）、术中低氧血症、微创手术均为术后低氧血症的危险因素（检验值分别为-2.566、12.352和0.033；P值分别为0.010、0.000和0.019）。多因素分析显示，术中低氧血症和BMI是术后低氧血症的独立危险因素[术中低氧血症：比值比（OR）=3.602，95%置信区间（95%CI）为1.143-3.817，P=0.001；BMI：OR=1.119，95%CI为1.026-1.208，P=0.036]。入住ICU后次日清晨低氧血症的改善率为63.0%（51/81）。肺功能障碍是低氧血症改善的独立危险因素（OR=0.200，95%CI为0.052-0.763，P=0.019）。
结论
术后可能早期发生低氧血症。术中低氧血症和BMI是术后低氧血症的独立危险因素。
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