早期低氧血症对重症监护病房全麻术后患者预后的影响

The impact of early hypoxemia on the prognosis of patients undergone general anesthesia patients in intensive care unit

目的评估重症监护病房（ICU）内全麻术后患者早期低氧血症的发生情况及其对预后的影响，以利于术后患者呼吸系统并发症预防策略的制定。方法回顾性分析2011年10月至2012年6月本院行择期全麻术后直接转入ICU患者的临床资料，根据转入ICU1h内的氧合指数（PaO2/FiO2）分为3组，〉300mmHg（1mmHg=0．133kPa）为血氧正常组（134例），200—300mmHg为轻度低氧组（88例），≤200mmHg为中重度低氧组（49例）。比较各组患者在机械通气时间、住ICU时间、术后至出院时间以及总吸氧时间上的差异。结果经筛选271例患者入组，3组间在性别、年龄、手术时间、手术类型以及是否术后拔管转入方面差异无统计学意义。低氧血症（PaO/FiO2≤300mmHg）患者占50．6％。中重度低氧组机械通气时间较血氧正常组明显延长[h：20．3（13．0，46．1）比12．5（6．0，17．5），D=40．803，P=0．005]，机械通气时间〉24h的比例较血氧正常组和轻度低氧组明显增多（44．4％比8．8％、16．1％，X^21=21．394、P1=0．000，X^22=9．368、P2=0．002）。中重度低氧组住ICU时间较血氧正常组和轻度低氧组明显延长[h：44．5（21．5，121．5）比22．0（18．0，46．5）、21．8（19．0，66．9），D1=54．302、P1=0．000，D2=44．171、P2=0．005]，术后至出院时间和总吸氧时间较血氧正常组明显延长[术后至出院时间（d）：15．0（12．0，21．5）比9．0（12．0，16．0），D=40．851，P=0．005；总吸氧时间（h）：170．0（97．5，307．5）比89．0（47．8，192．0），D=45．049，P=0．002]。结论全麻术后早期低氧血症在ICU相当普遍，PaO2/FiO2≤200mmHg与患者机械通气时间、住ICU时间、术后至出院时间及总吸氧时间延长密切相关。

Objective To form the strategy of prevention of postoperative pulmonary complication, investigate the incidence of early hypoxemia after general anesthesia for surgery in intensive care unit （ ICU ）, and assess its impact on the prognosis of patients. Methods Clinical data of patients who were directed transferred to ICU after general anesthesia for selective surgery during October 2011 to June 2012 were analyzed retrospectively. According to the oxygenation index （PaOJFiO2） obtained in 1 hour after ICU admission, patients were divided into three groups, normal blood oxygen level （n=134, PaO2/FiO2〉300 mm Hg, 1 mm Hg=0.133 kPa）, mild hypoxia （n=88, PaO2/FiO2 200-300 mm Hg） and moderate to severe hypoxia （n =49, PaO2/FiO2 ≤ 200 mm Hg） groups. Duration of mechanical ventilation, ICU stay days, postoperative hospital stay days, and duration of oxygen therapy were compared among three groups. Results Two hundred and seventy-one patients were included. There were no statistical differences in gender, age, duration of operation, type of operation, and postoperative extubation. The incidence rate of hypoxemia （PaO2/FiO2 ≤ 300 mm Hg） was 50.6%. Duration of mechanical ventilation was significantly prolonged in moderate to severe hypoxia group as compared with normal blood oxygen group [hours： 20.3 （ 13.0, 46.1 ） vs. 12.5 （6.0, 17.5）, D=40.803, P=0.005 ], the ratio of duration of mechanical ventilation longer than 24 hours was significantly higher in moderate to severe hypoxia group compared with normal blood oxygen and mild hypoxia groups （44.4% vs. 8.8%, 16.1%, X^21=21.394, P1~=0.000; X^22=9.368, P2=0.002）. The ICU stay was significantly longer in moderate to severe hypoxia group than normal blood oxygen and mild hypoxia groups [hours： 44.5 （21.5, 121.5） vs. 22.0 （18.0, 46.5）, 21.8 （19.0, 66.9）, D1=54.302, P1=0.000; D2=44.171, P2=0.005]. Compared with normal blood oxygen group, postoperative hospital stay days and duration of oxygen therapy were significantly longer in moderate to severe hypoxia group [postoperative length of stay （days） ： 15.0 （12.0, 21.5） vs. 9.0 （12.0, 16.0）, D=40.851, P=0.005; duration of oxygen therapy （hours）： 170.0 （97.5, 307.5） vs. 89.0 （47.8, 192.0）, D=45.049, P=0.002]. Conclusions The incidence of hypoxemia postoperative patients after general anesthesia is high when transferred to ICU. PaO2/FiO2 ≤ 200 mm Hg was closely related to prolonged duration of mechanical ventilation, ICU stay days, postoperative hospital stay davs. and duration of oxwen theranv.