术中呼气末二氧化碳与大腹部手术后器官功能障碍的关系：一项队列研究。
Association between intraoperative end-tidal carbon dioxide and postoperative organ dysfunction in major abdominal surgery: A cohort study.
机构信息
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan.
出版信息
PLoS One. 2023 Mar 10;18(3):e0268362. doi: 10.1371/journal.pone.0268362. eCollection 2023.
BACKGROUND
Data on the effects of intraoperative end-tidal carbon dioxide (EtCO2) levels on postoperative organ dysfunction are limited. Thus, this study was designed to investigate the relationship between the intraoperative EtCO2 level and postoperative organ dysfunction in patients who underwent major abdominal surgery under general anesthesia.
METHODS
We conducted a cohort study involving patients who underwent major abdominal surgery under general anesthesia at Kyoto University Hospital. We classified those with a mean EtCO2 of less than 35 mmHg as low EtCO2. The time effect was determined as the minutes when the EtCO2 value was below 35 mmHg, whereas the cumulative effect was evaluated by measuring the area below the 35-mmHg threshold. The outcome was postoperative organ dysfunction, defined as a composite of at least one organ dysfunction among acute renal injury, circulatory dysfunction, respiratory dysfunction, coagulation dysfunction, and liver dysfunction within 7 days after surgery.
RESULTS
Of the 4,171 patients, 1,195 (28%) had low EtCO2, and 1,428 (34%) had postoperative organ dysfunction. An association was found between low EtCO2 and increased postoperative organ dysfunction (adjusted risk ratio, 1.11; 95% confidence interval [CI], 1.03-1.20; p = 0.006). Additionally, long-term exposure to EtCO2 values of less than 35 mmHg (≥224 min) was associated with postoperative organ dysfunction (adjusted risk ratio, 1.18; 95% CI, 1.06-1.32; p = 0.003) and low EtCO2 severity (area under the threshold) (adjusted risk ratio, 1.13; 95% CI, 1.02-1.26; p = 0.018).
CONCLUSIONS
Intraoperative low EtCO2 of below 35 mmHg was associated with increased postoperative organ dysfunction.
背景
关于术中呼气末二氧化碳（EtCO2）水平对术后器官功能障碍的影响的数据有限。因此，本研究旨在调查全身麻醉下接受大腹部手术的患者术中 EtCO2 水平与术后器官功能障碍之间的关系。
方法
我们进行了一项队列研究，纳入了在京都大学医院接受全身麻醉下大腹部手术的患者。我们将平均 EtCO2 低于 35mmHg 的患者归类为低 EtCO2 组。时间效应定义为 EtCO2 值低于 35mmHg 的分钟数，而累积效应则通过测量低于 35mmHg 阈值的面积来评估。术后器官功能障碍的结局定义为术后 7 天内至少有一种急性肾损伤、循环功能障碍、呼吸功能障碍、凝血功能障碍和肝功能障碍的复合器官功能障碍。
结果
在 4171 名患者中，有 1195 名（28%）患者的 EtCO2 较低，有 1428 名（34%）患者发生术后器官功能障碍。低 EtCO2 与术后器官功能障碍增加相关（校正风险比，1.11；95%置信区间[CI]，1.03-1.20；p=0.006）。此外，长期暴露于低于 35mmHg 的 EtCO2 值（≥224 分钟）与术后器官功能障碍（校正风险比，1.18；95%CI，1.06-1.32；p=0.003）和低 EtCO2 严重程度（阈值下面积）（校正风险比，1.13；95%CI，1.02-1.26；p=0.018）相关。
结论
术中 EtCO2 低于 35mmHg 与术后器官功能障碍增加相关。
Zotero 插件