【罂粟摘要】术中氧气补充与远期死亡率的多重交叉集群试验的亚组分析
术中氧气补充与远期死亡率的多重交叉集群试验的亚组分析
术中氧气补充是否会使增加患者的远期死亡率尚不清楚，以往的试验结果相互矛盾。因此，作者验证了以下假设：补充氧气（80％比30％）会增加患者远期死亡的风险。
作者对一项大型多重交叉集群试验进行了事后分析。该试验初步纳入了共行5,000例以上结直肠手术的4,088名成年患者，患者在全身麻醉期间接受30％或80％的吸氧。作者评估了80％与30％目标吸氧相比，对远期死亡率和Kaplan-Meier生存的影响。因为作者可以从俄亥俄州卫生局（俄亥俄州哥伦布）获得可靠的生命状态信息，因此本研究分析纳入的仅限于在俄亥俄州有家庭住址的患者。
最终纳入共行3,471例符合条件的结直肠手术的2,801名患者进行分析，其中包括在1,577名患者中接受了80％的氧气的1,753例（51％）手术，以及在1,551名患者中进行了30％的氧气的1,718例手术。在中位数3年后，观察到的死亡发生率在80％氧气组中为13％（234/1,753），在30％氧气组中为14％（245/1,718），两组间死亡风险比为0.94（95％CI，0.78-1.13；P = 0.493）。
在这项大型对照试验的事后分析中，氧气补充并没有增加术后死亡率。
翻译：易菁 编辑：佟睿 审校：曹莹
Supplemental Intraoperative Oxygen and Long-term Mortality: Subanalysis of a Multiple Crossover Cluster Trial
BACKGROUND: Whether supplemental oxygen worsens long-term mortality remains unclear, with contradictory trial results. The authors therefore tested the hypothesis that supplemental oxygen (80% vs. 30%) increases the hazard for long-term mortality.
METHODS: The authors conducted a post hoc analysis of a large multiple crossover cluster trial in which more than 5,000 colorectal surgeries on 4,088 adults were allocated to receive either 30% or 80% inspired oxygen during general anesthesia. The authors assessed the effect of 80% versus 30% target-inspired oxygen on long-term mortality and calculated Kaplan-Meier survival estimates. Analysis was restricted to patients with a home address in Ohio because the authors could obtain reliable vital status information from the Ohio Department of Health (Columbus, Ohio) for them.
RESULTS: A total of 3,471 qualifying colorectal surgeries performed in 2,801 patients were analyzed, including 1,753 (51%) surgeries in 1,577 patients given 80% oxygen and 1,718 surgeries in 1,551 patients given 30% oxygen. The observed incidence of death after a median of 3 yr was 13% (234 of 1,753) in the 80% oxygen group and 14% (245 of 1,718) in the 30% oxygen group. The estimated hazard ratio for mortality was 0.94 (95% CI, 0.78 to 1.13; P = 0.493).
CONCLUSIONS: In this post hoc analysis of a large, controlled trial, supplemental oxygen did not increase postoperative mortality.