麻醉诱导时预充氧后低氧血症的发生率及危险因素
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Incidence and risk factors of hypoxaemia after preoxygenation at induction of anaesthesia
背景与目的
与气道管理相关的低氧血症的发生率仍然是一个值得关注的问题。我们的目的是确定在标准化预充氧后麻醉诱导过程中低氧血症的危险因素。
方 法
本研究是一项多中心、前瞻性、观察试验，评估了成年患者麻醉诱导时低氧血症的发生率，主要指标终点是低血氧血症的发生率，低氧血症定义为动脉血氧饱和度（SpO2）<95%。
结 果
本研究共纳入2398例患者中，158（6.6%）例患者出现低氧血症。确定了五个术前独立的危险因素：慢性阻塞性肺疾病、高血压、预期困难面罩通气和困难气管插管以及急诊手术。 还有三个诱导前独立的危险因素：预充氧困难，面罩通气困难及气管插管困难。我们发现术前危险因素对面罩通气困难的预测值为0.96（0.95-0.96），气管插管困难的预测值为0.95（0.94-0.96）。 共有723名患者（30%）预充氧困难（FeO2<90%），其中男性、慢性阻塞性肺病、高血压、急诊手术和预计的困难面罩通气是患者发生氧合困难独立的危险因素。
结 论
困难面罩通气和困难气管插管是全身麻醉诱导时低血氧血症的危险因素，30%的患者出现难以预充氧的情况，并确定为低血氧血症发生的危险因素。
原始文献摘要
C. Baillard, M. Boubaya, E. Statescu;Incidence and risk factors of hypoxaemia after preoxygenation at induction of anaesthesia;British Journal of Anaesthesia, xxx (xxx): xxx (xxxx);doi: 10.1016/j.bja.2018.11.022
Background: The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure.
Methods: The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2) <95%.
Results: Of 2398 patients, hypoxaemia was observed in 158 (6.6%). We identified five preoperative independent risk factors: chronic obstructive pulmonary disease, hypertension, anticipated difficult mask ventilation and difficult tracheal intubation, and emergency surgery. There were also three pre-induction independent risk factors: difficult preoxygenation, difficult mask ventilation, and difficult tracheal intubation. We found a high negative predictive value of preoperative risk factors for difficult mask ventilation of 0.96 (0.95-0.96), and for difficult tracheal intubation (0.95[0.94-0.96]). A total of 723 patients (30%) experienced difficult preoxygenation (FeO2 <90% at the end of preoxygenation). Male sex, chronic obstructive pulmonary disease, hypertension, emergency surgery, and predictable difficult mask ventilation were independent patient risk factors for difficult preoxygenation.
Conclusions: Difficult mask ventilation and difficult tracheal intubation are risk factors for hypoxaemia at induction of general anaesthesia. Difficult preoxygenation was observed in 30% of patients and was also identified as a risk factor for hypoxaemia. This suggests that techniques improving preoxygenation should be implemented in daily practice.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙编辑：何幼芹 审校：王贵龙