麻醉后恢复室患者低氧血症发生率及高危因素的回顾性分析

基础医学与临床 ›› 2020, Vol. 40 ›› Issue (9): 1242-1246.

麻醉后恢复室患者低氧血症发生率及高危因素的回顾性分析

张良燕¹, 唐帅^1*, 张秀华¹, 韩伟², 薛杨¹, 田伊¹, 黄宇光¹

1.中国医学科学院北京协和医学院北京协和医院麻醉科, 北京 100730;
2.中国医学科学院基础医学研究所北京协和医学院基础学院流行病与卫生统计系, 北京 100005

收稿日期:2020-03-01 修回日期:2020-06-29 出版日期:2020-09-05 发布日期:2020-09-04
通讯作者: ^*tangshuai@pumch.cn

Incidence of hypoxemia in a post-anesthesia care unit and relevant risk factors

ZHANG Liang-yan¹, TANG Shuai^1*, ZHANG Xiu-hua¹, HAN Wei², XUE Yang¹, TIAN Yi¹, HUANG Yu-guang¹

1. Department of Anesthesiology, Peking Union Medical College Hospital,CAMS & PUMC, Beijing 100730;
2. Department of Epidemiology and Health Statistics, Institute of Basic Medical Sciences CAMS, School of Basic Medicine PUMC, Beijing 100005, China

Received:2020-03-01 Revised:2020-06-29 Online:2020-09-05 Published:2020-09-04
Contact: ^*tangshuai@pumch.cn

摘要/Abstract

摘要： 目的研究麻醉后恢复室(PACU)患者低氧血症的发生情况,探寻可能的高危因素。方法收集相关临床数据,回顾性分析1年内PACU收治的14 604例全身麻醉患者,对其低氧血症发生率和影响因素进行统计学分析。结果总低氧血症发生率为2.79%,多元回归分析显示年龄≥65岁、体质指数(BMI)≥25 kg/m²、美国麻醉医师协会(ASA)分级Ⅱ级以上、四肢大手术和胸科手术后的患者发生低氧血症的风险明显增加。结论低氧血症是PACU内常见的并发症,年龄、BMI、ASA分级、手术部位与低氧血症发生密切相关。临床医生应关注高危患者,及时干预,减少PACU内低氧血症的发生。

关键词: 低氧血症, 脉搏氧饱和度, 麻醉后恢复室

Abstract: Objective To investigate the incidence and potential risk factors of postoperative hypoxemia in a post-anesthesia care unit (PACU). Methods The retrospective cohort assessed 14 604 postoperative patients who were admitted to PACU in a period of one year. Clinical data were collected, the incidence and potential risk factors for postoperative hypoxemia were statistically analyzed. Results The incidence of hypoxemia was 2.79%. Multiple regression analysis indicated that the risk factors were age (≥65-year old), body mass index (BMI≥25), American Society of Anesthesiologists (ASA ≥Ⅱ), limb surgery, and thoracic surgery. Conclusions Hypoxemia is common in postoperative patients in PACU. Age, BMI, ASA classification, and surgical site are associated with postoperative hypoxemia. Doctors should pay attention and give timely treatment to high-risk patients to prevent hypoxemia in PACU.

Key words: hypoxemia, pulse oxygen saturation, post-anesthesia care unit

中图分类号:

R614

张良燕, 唐帅, 张秀华, 韩伟, 薛杨, 田伊, 黄宇光. 麻醉后恢复室患者低氧血症发生率及高危因素的回顾性分析[J]. 基础医学与临床, 2020, 40(9): 1242-1246.

ZHANG Liang-yan, TANG Shuai, ZHANG Xiu-hua, HAN Wei, XUE Yang, TIAN Yi, HUANG Yu-guang. Incidence of hypoxemia in a post-anesthesia care unit and relevant risk factors[J]. Basic & Clinical Medicine, 2020, 40(9): 1242-1246.

参考文献

[1] Ward DS, Karan SB, Pandit JJ. Hypoxia: developments in basic science, physiology and clinical studies[J]. Anaesthesia, 2011, 66: 19-26.
[2] Powell JF, Menon DK, Jones JG. The effects of hypoxemia and recommendations for postoperative oxygen therapy[J]. Anaesthesia, 1996, 51: 769-772
[3] Sun Z, Sessler DI, Dalton JE, et al. Postoperative hypoxemia is common and persistent: A prospective blinded observational study[J]. Anesth Analg, 2015, 121: 709-715.
[4] Aust H, Kranke P, Eberhart, LH, et al. Impact of medical training and clinical experience on the assessment of oxygenation and hypoxemia after general anesthesia: an observational study[J]. J Clin Monit Comput, 2015, 29: 415-426.
[5] Daley MD, Norman PH, Colmenares ME, et al. Hypoxemia in adults in the post-anesthesia care unit[J]. Can J Anaesth, 1991, 38: 740-746.
[6] Morris RW, Buschman A, Warren DL, et al. The prevalence of hypoxemia detected by pulse oximetry during recovery from anesthesia[J]. J Clin Monit, 1988, 4: 16-20.
[7] Mathes DD, Conaway MR, Ross WT. Ambulatory surgery: Room air versus nasal cannula oxygen during transport after general anesthesia[J]. Anesth Analg, 2001, 93: 917-921.
[8] Dunham CM, Hileman BM, Hutchinson AE, et al. Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: A retrospective study of consecutive patients[J]. BMC Anesthesiol, 2014, 14: 43-52.
[9] Ahmad S, Nagle A, McCarthy RJ, et al. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery[J]. Anesth Analg, 2008, 107: 138-143.
[10] Xue FS, Li BW, Zhang GS, et al. The influence of surgical sites on early postoperative hypoxemia in adults undergoing elective surgery[J]. Anesth Analg, 1999, 88: 213-219.
[11] Murphy GS, Szokol JW, Franklin M, et al. Postanes-thesia care unit recovery times and neuromuscular block-ing drugs: A prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium[J]. Anesth Analg, 2004, 98: 193-200.
[12] Murphy GS, Szokol JW, Avram MJ, et al. Residual neuromuscular block in the elderly: Incidence and clinical implications[J]. Anesthesiology, 2015, 123: 1322-1336.

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