术后转入ICU患者出现低氧血症的危险因素分析

Risk factors of hypoxemia in patients admitted to intensive care unit after surgery

目的分析外科术后转入重症监护病房(ICU)复苏患者出现低氧血症的危险因素。方法回顾性分析2020年6月至8月转入山东大学附属省立医院重症医学科进行复苏的220例外科术后患者的临床资料。以患者入ICU 30 min氧合指数分为低氧血症组(≤300 mmHg,1 mmHg≈0.133 kPa)和非低氧血症组(>300 mmHg)。比较两组患者的围手术期临床资料,分析术后患者早期发生低氧血症的危险因素;观察低氧血症患者入ICU次日晨氧合指数改善情况,分析与低氧血症改善相关的因素。结果220例术后患者低氧血症发生率为36.8%(81/220),其中普外科术后患者低氧血症病例数最多,占42.0%(34/81);骨科低氧血症发生率最高,达53.3%(16/30)。单因素分析表明,体质量指数(BMI)、术中出现低氧血症、微创手术均是影响术后发生低氧血症的危险因素(检验值分别为-2.566、12.352、0.033,P值分别为0.010、0.000、0.019)。多因素分析显示,术中出现低氧血症和BMI均为术后患者发生低氧血症的独立危险因素〔术中低氧血症:优势比(OR)=3.602,95%可信区间(95%CI)为1.143~3.817,P=0.001;BMI:OR=1.119,95%CI为1.026~1.208,P=0.036〕。81例发生低氧血症患者入ICU次日晨低氧血症改善率为63.0%(51/81);肺功能障碍为影响术后患者低氧血症改善的独立危险因素(OR=0.200,95%CI为0.052~0.763,P=0.019)。结论外科术后早期可发生低氧血症,术中低氧血症和BMI为术后发生低氧血症的独立危险因素。

Objective To investigate the risk factors of postoperative hypoxemia in patients admitted to intensive care unit(ICU)for resuscitation.Methods Clinical data of 220 postoperative patients admitted to the ICU for resuscitation in Shandong Provincial Hospital Affiliated to Shandong University from June to August 2020 were collected and retrospectively analyzed.According to their oxygenation index within 30 minutes after admission to ICU,they were divided into hypoxemia group(oxygenation index≤300 mmHg,1 mmHg≈0.133 kPa)and non-hypoxemia group(oxygenation index>300 mmHg).Baseline data and perioperative indicators were compared between the two groups,and risk factors for early postoperative hypoxemia were analyzed.The improvement of oxygenation index of patients with hypoxemia in next morning after admission to ICU was observed,and the factors related to the improvement of hypoxemia were analyzed.Results The incidence of hypoxemia was 36.8%(81/220)in the cohort.The majority cases of hypoxemia were from general surgery department,accounting for 42.0%(34/81).The incidence rate of hypoxemia from orthopaedic was the highest at 53.3%(16/30).Univariate analysis showed that body mass index(BMI),intraoperative hypoxemia,minimally invasive surgery were all risk factors of postoperative hypoxemia(test values were-2.566,12.352 and 0.033;P values were 0.010,0.000 and 0.019,respectively).Multivariate analysis showed that intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia[intraoperative hypoxemia:odds ratio(OR)=3.602,95%confidence interval(95%CI)was 1.143-3.817,P=0.001;BMI:OR=1.119,95%CI was 1.026-1.208,P=0.036].The improvement rate of hypoxemia next morning after admission to ICU was 63.0%(51/81).Pulmonary dysfunction was the independent risk factor for the improvement of hypoxemia(OR=0.200,95%CI was 0.052-0.763,P=0.019).Conclusions Hypoxemia might occur early after surgery.Intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia.