Reich D L, Timcenko A, Bodian C A, Kraidin J, Hofman J, DePerio M, Konstadt S N, Kurki T, Eisenkraft J B
Department of Anesthesiology, Mount Sinai School of Medicine, New York, USA.
Anesthesiology. 1996 Apr;84(4):859-64. doi: 10.1097/00000542-199604000-00013.
Pulse oximeters have been reported to fail to record data in 1.12-2.50% of cases in which anesthesia records were handwritten. There is reason to believe that these may be underestimates. Computerized anesthesia records may provide insight into the true incidence of pulse oximetry data failures and factors that are associated with such failures.
The current study reviewed case files of 9,203 computerized anesthesia records. Pulse oximetry data failure was defined as the presence of at least one continuous gap in data > or = 10 min in duration in a case. A multivariate logistic regression model was used to identify predictors of pulse oximetry data failure, and a modified case-control method was used to determine whether extremes of blood pressure and hypothermia during the procedure were associated with pulse oximetry data failure.
The overall incidence of cases that had at least one continuous gap of > or = 10 min in pulse oximetry data was 9.18%. The independent preoperative predictors of pulse oximetry data failure were ASA physical status 3,4, or 5 and orthopedic, vascular, and cardiac surgery. Intraoperative hypothermia, hypotension, hypertension, and duration of procedure were also independent risk factors for pulse oximetry data failure.
Pulse oximetry data failure rates based on review of computerized records were markedly greater than those previously reported. Physical status, type of surgery, and intraoperative variables were risk factors for pulse oximetry data failure. Regulations and expectations regarding pulse oximetry monitoring should reflect the limitations of the technology.
据报道，在手写麻醉记录的病例中，脉搏血氧仪有1.12%-2.50%的情况无法记录数据。有理由相信这些可能是低估的数据。计算机化麻醉记录可能有助于深入了解脉搏血氧饱和度数据失败的真实发生率以及与此类失败相关的因素。
本研究回顾了9203份计算机化麻醉记录的病例档案。脉搏血氧饱和度数据失败定义为病例中存在至少一个持续时间≥10分钟的数据连续中断。使用多因素逻辑回归模型来确定脉搏血氧饱和度数据失败的预测因素，并使用改良的病例对照方法来确定手术过程中的血压极值和体温过低是否与脉搏血氧饱和度数据失败有关。
脉搏血氧饱和度数据中至少有一个持续时间≥10分钟的连续中断的病例的总体发生率为9.18%。脉搏血氧饱和度数据失败的术前独立预测因素是美国麻醉医师协会（ASA）身体状况3、4或5以及骨科、血管和心脏手术。术中体温过低、低血压、高血压和手术持续时间也是脉搏血氧饱和度数据失败的独立危险因素。
基于计算机化记录审查的脉搏血氧饱和度数据失败率明显高于先前报道的比率。身体状况、手术类型和术中变量是脉搏血氧饱和度数据失败的危险因素。关于脉搏血氧饱和度监测的规定和期望应反映该技术的局限性。
