肺超声评分预测PACU患者气管拔管后新发低氧血症的准确性

Accuracy of lung ultrasound score in predicting emerging hypoxemia after tracheal extubation in patients in postanesthesia care unit

目的评价肺超声评分(LUSS)预测PACU患者气管拔管后新发低氧血症的准确性。方法择期腹部手术患者333例,性别不限,年龄18~89岁,ASA分级Ⅰ~Ⅲ级,分别于术前(T0)和入PACU(T1)时行肺超声检查(LUS),评分记为LUSS0和LUSS1。于气管拔管后20 min(T2)时行动脉血气分析,PaO_(2)/FiO_(2)<300 mmHg为低氧血症组,PaO_(2)/FiO_(2)≥300 mmHg为非低氧血症组。采用多因素logistic回归和受试者工作特征(ROC)曲线分析,评估LUSS预测PACU患者气管拔管后新发低氧血症的准确性。结果PACU患者气管拔管后新发低氧血症发生率为9.0%。多因素logistic回归分析结果显示,LUSS1和BMI是PACU患者气管拔管后新发低氧血症的独立危险因素,LUSS1的ROC曲线下面积为0.873(P<0.01,95%CI 0.812~0.935)。LUSS1<7分的患者气管拔管后新发低氧血症风险低(LR-=0.15,95%CI 0.05~0.45),LUSS1>10分的患者气管拔管后新发低氧血症风险高(LR+=17.25,95%CI 7.35~40.51)。结论LUSS可有效预测PACU患者气管拔管后低氧血症的发生。

Objective To evaluate the accuracy of lung ultrasound score(LUSS)in predicting emerging hypoxemia after tracheal extubation in the patients in postanesthesia care unit(PACU).Methods A total of 333 patients of both sexes,aged 18-89 yr,of American Society of Anesthesiologist physical statusⅠ-Ⅲ,scheduled for elective abdominal surgery,were included in the study.Lung ultrasound examinations were performed before operation(T0)and on admission to PACU(T1),and the LUSS were recorded as LUSS0 and LUSS1.Arterial blood gas analysis was conducted at 20 min after tracheal extubation,and oxygenation index(PaO_(2)/FiO_(2))were recorded.Patients were divided into 2 groups according to the oxygenation index:PaO_(2)/FiO_(2)<300 mmHg group(hypoxemia group),and PaO_(2)/FiO_(2)≥300 mmHg group(non-hypoxemia group).Multivariate logistic regression analysis and the receiver operating characteristic curve were used to evaluate the accuracy of LUSS1 in predicting the emerging hypoxemia after extubation in the patients in PACU.Results The incidence of emerging hypoxemia in PACU after extubation was 9.0%.Multivariate logistic regression analysis indicated that LUSS1 and body mass index were independent risk factors for emerging hypoxemia after extubation in the patients in PACU.The area under the ROC curve for LUSS1 was 0.873(P<0.001,95%CI 0.812-0.935).The patients with LUSS1<7 had a lower risk of hypoxemia after extubation(LR-=0.15,95%CI 0.05-0.45),and the patients with LUSS1>10 had a higher risk of hypoxemia after extubation(LR+=17.25,95%CI 7.35-40.51).Conclusion LUS can effectively predict the development of hypoxemia after tracheal extubation in the patients in PACU.