以脉搏血氧饱和度为导向的个体化吸氧预防结直肠手术中的高氧血症并减少术后肺不张：一项随机对照试验。

Individual FiO guided by SO prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial.

作者信息

Wei Xia, Kang Xia, Zhang Lijun, Huang Jinzhu, Feng Weiyu, Duan Pengyu, Zhang Bing

机构信息

Department of Anesthesiology, Harbin Medical University Cancer Hospital, China.

Department of Anesthesiology, HongHui Hospital, Xi'an JiaoTong University, China.

出版信息

J Clin Anesth. 2025 Feb;101:111732. doi: 10.1016/j.jclinane.2024.111732. Epub 2024 Dec 26.

DOI:10.1016/j.jclinane.2024.111732

PMID:39729933

Abstract

STUDY OBJECTIVE

To determine whether individualized fraction of inspired oxygen (iFiO) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO.

DESIGN

This was a single-center, prospective, randomized study.

SETTING

This study was conducted in a single tertiary care hospital in China.

PATIENTS

A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.

INTERVENTIONS

The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO group) or individualized FiO based on physiological SpO (iFiO group).

MEASUREMENTS

The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO, oxygenation index, alveolar-arterial oxygen tension gradient (A-aDO), and pulmonary shunt fraction (Qs/Qt) were considered.

MAIN RESULTS

The LUS was significantly lowered in the iFiO group (5 [4, 7]) compared with the fFiO group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO group (P = 0.025). At the end of surgery, PaO, A-aDO, and Qs/Qt were significantly reduced in patients in the iFiO group compared with those in the fFiO group.

CONCLUSIONS

The use of iFiO during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.

CLINICAL TRIAL REGISTRATION

ChiCTRT2100049615.

摘要

研究目的

确定与60%的吸入氧分数（FiO₂）相比，个体化吸入氧分数（iFiO₂）是否能改善择期腹腔镜结直肠手术后的肺不张情况。

设计

这是一项单中心、前瞻性、随机研究。

地点

本研究在中国一家三级甲等医院进行。

患者

共有84例在2021年8月至2022年5月期间接受择期腹腔镜结直肠手术的符合条件的住院患者纳入本研究。

干预措施

患者被随机分配接受固定吸入氧分数（fFiO₂组）或基于生理血氧饱和度（SpO₂）的个体化FiO₂（iFiO₂组）。

测量指标

主要结局是拔管后30分钟的肺部超声评分（LUS）。次要结局包括住院时间、入住重症监护病房情况、麻醉后护理单元停留时间、术后第三天肺容量与术前相比的比值、恶心呕吐发生率以及术后手术部位感染情况。此外，还考虑气道平台压、气道峰压、肺动态顺应性、动脉血氧分压（PaO₂）、氧合指数、肺泡 - 动脉血氧分压差（A - aDO₂）和肺分流分数（Qs/Qt）。

主要结果

与fFiO₂组（8 [4, 10]）相比，iFiO₂组的LUS显著降低（5 [4, 7]）（P = 0.03）。根据肺不张的判定标准，fFiO₂组有25例患者（62.5%）发生明显肺不张，而iFiO₂组为15例患者（37.5%）（P = 0.025）。手术结束时，与fFiO₂组患者相比，iFiO₂组患者的PaO₂、A - aDO₂和Qs/Qt显著降低。