高氧对心脏手术患者临床结局的影响
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The impact of hyperoxia on outcomes after cardiac surgery: a systematic review and narrative synthesis
背景与目的：心脏手术患者术中常常接受高氧气水平的治疗，以防止手术和体外循环的非生理性固有的细胞缺氧风险。但这可能导致过度活性氧产生和缺血-再灌注损伤的恶化。在本试验纳入所有相关的随机对照试验（RCTs），以研究高氧对术后器官功能障碍，住院时间和心脏手术患者死亡率的影响。
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方法：本研究检索了Medline，Embase，Scopus和Cochrane数据库，比较心脏手术患者的氧合策略对临床结局的影响。主要指标：术后心肌酶水平，急性肾损伤和神经功能障碍，术后器官功能障碍。次要指标：死亡率，机械通气天数以及住院时间。
结果：本研究共纳入12个符合纳入标准的随机对照试验。除一项试验外，所有偏倚风险均不高，手术期间的氧疗时间和氧合水平的异质性明显，并且排除了荟萃分析。大多数试验发现高氧和常氧对临床结局影响无区别。两项试验表明术后心肌酶降低，一项试验表明常氧组机械通气时间缩短。
结论：在成人心脏手术中，高氧对器官功能障碍、住院时间和死亡率影响很小
Heinrichs J, Lodewyks C, Neilson C, et al. The impact of hyperoxia on outcomes after cardiac surgery: a systematic review and narrative synthesis.[J]. Canadian Journal of Anaesthesia, 2018(101).
BACKGROUND:Historically, cardiac surgery patients have often been managed with supraphysiologic intraoperative oxygen levels to protect against the risks of cellular hypoxia inherent in the un-physiologic nature of surgery and cardiopulmonary bypass. This may result in excessive reactive oxygen species generation and exacerbation of ischemia-reperfusion injury. In this review, we synthesize all available data from randomized controlled trials (RCTs) to investigate the impact that hyperoxia has on postoperative organ dysfunction, length of stay, and mortality during adult cardiac surgery.
METHODS:We searched Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials databases using a high-sensitivity strategy for RCTs that compared oxygenation strategies for adult cardiac surgery.Our primary outcome was postoperative organ dysfunction defined by postoperative increases in myocardial enzymes,acute kidney injury, and neurologic dysfunction. Secondary outcomes were mortality, ventilator days, and length of stay in the hospital and intensive care unit.
RESULTS:We identified 12 RCTs that met our inclusion criteria. Risk of bias was unclear to high in all but one trial. Significant heterogeneity in timing of the treatment period and the oxygenation levels targeted was evident and precluded meta-analysis. The large majority of trials found no difference between hyperoxia and normoxia for any outcome. Two trials reported reduced postoperative myocardial enzymes and one trial reported reduced mechanical ventilation time in the normoxia
group.
CONCLUSIONS:Hyperoxia had minimal impact on organ dysfunction, length of stay, and mortality in adult cardiac surgery. The current evidence base is small,heterogeneous, and at risk of bias.
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