肌肉组织低氧饱和度与肺癌手术患者肺炎：一项队列研究。

Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery: a cohort study.

机构信息

Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.

Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.

出版信息

Chin Med J (Engl). 2023 Jan 5;136(1):65-72. doi: 10.1097/CM9.0000000000002497.

DOI:10.1097/CM9.0000000000002497

PMID:36780417

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10106230/

Abstract

BACKGROUND

Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.

METHODS

This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO 2 ) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO 2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO 2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression. The secondary outcome was the correlation between SmtO 2 in the forearm and that in the thigh.

RESULTS

We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO 2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.

CONCLUSION

Muscular tissue desaturation, defined as a baseline SmtO 2 < 80% in the forearm, may be associated with an increased risk of POP.

TRIAL REGISTRATION

No. ChiCTR-ROC-17012627.

摘要

背景

术后肺炎（POP）是肺癌手术的常见并发症，肌肉组织氧合是术后并发症的根本原因。然而，接受肺癌手术的患者肌肉组织去饱和与 POP 之间的关联尚未得到专门研究。本研究旨在探讨术中肌肉组织去饱和作为预测肺癌手术后 POP 的可能性。

方法

这项队列研究纳入了接受肺叶切除术和单肺通气的患者（≥55 岁）。使用组织血氧饱和度仪在手前臂（肱二头肌上方）和大腿上部（股四头肌上方）监测肌肉组织氧饱和度（SmtO2）。SmtO2 的最低值是任何时间点的最低术中测量值。肌肉组织去饱和定义为基线 SmtO2 低于 80%并持续>15s。去饱和的最低基线 SmtO2 低于 80%的时间点，去饱和的最低基线 SmtO2 低于 80%的幅度和时间的乘积即为阈值以上或以下的面积。主要结局是使用多变量逻辑回归分析术后 7 天内术中肌肉组织去饱和与 POP 之间的关联。次要结局是前臂和大腿 SmtO2 之间的相关性。

结果

我们共纳入 174 名患者。总体肌肉去饱和（定义为基线时前臂 SmtO2 <80%）的发生率约为 47.1%（82/174）。发生肌肉去饱和的患者肺炎发生率高于未发生去饱和的患者（28.0%[23/82]比 12.0%[11/92]；P=0.008）。多变量分析显示，在调整年龄、美国麻醉医师协会状态、加泰罗尼亚外科患者呼吸风险评估、吸烟、使用周围神经阻滞、异丙酚和研究中心后，肌肉去饱和与肺炎风险增加相关（优势比：2.995，95%置信区间：1.080-8.310，P=0.035）。