围手术期低动脉氧合与增加心脏外科手术后的脑中风危险有关
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Perioperative Low Arterial Oxygenation Is Associated With Increased Stroke Risk in Cardiac Surgery.
背景与目的
患者特征和术中因素都与心脏手术后的脑中风危险相关。我们假设围手术期的全身氧合不足与心肺转流后的脑中风危险增加有关。
方 法
在本研究中，对于2003年至2006年在单个中心进行心肺分流手术的251名成人患者，将患者（患者手术后至少术后24小时内中风）与无中风的对照组以1：2进行比较。动脉血中氧气的最小和平均分压（PaO2），术后24小时内的动脉血气值被评估为连续和分类的预测因子。对潜在因素进行条件逻辑回归模型（人口统计学，合并症和术中变量）来评估PaO2变量与中风状态之间的关联性。
结 果
低PaO2值与术后中风相关，PaO2每降低10 mm Hg，中风的可能性增加超过20％（优势比[OR],1.23; 95% 置信区间[CI],1.07-1.41)。当考虑到平均PaO2时，中风的可能性也增加(校正OR,每个平均PaO2的下四分位数是1.39; 95% CI, 1.05-1.83)。最低低PaO2值与其它四分位数相比，中风机率增加了2.41倍（95％CI，1.22-4.78）。除了平均PaO2，最低点的四分位数，在多重比较后仍然显著。
结 论
心脏手术后24小时内，低PaO2与患者心脏手术后脑中风增加有关，结果应在独立队列中进行验证。进一步探讨缺氧发作的潜在因素对于改善患者预后是重要的。
原始文献摘要
Dunham AM,Grega MA，Brown CH ,et al.Perioperative Low Arterial Oxygenation Is Associated With Increased Stroke Risk in Cardiac Surgery.Anesthesia & Analgesia.125(1):38-43, July 2017.doi: 10.1213/ANE.0000000000002157
Background.
Both patient characteristics and intraoperative factors have been associated witha higher risk of stroke after cardiac surgery.We hypothesized that poorsystemic oxygenation inthe perioperative periodis associated with increased risk of stroke following cardiopulmonary bypass
METHODS:
In this study of 251 adult patients who underwent cardiopulmonary bypass procedures at a single center from 2003 to 2006, cases (patients with a postoperative stroke at least 24 hours after surgery) were matched 1:2 to controls without stroke. Minimum and average partial pressure of oxygen in arterial blood (PaO2) values, from arterial blood gas values during and up to 24 hours after surgery, were evaluated as continuous and categorical predictors. Conditional logistic regression models adjusted for potential confounders (demographics,comorbidities,andintraoperativevariables)wereusedto evaluateassociations between PaO2 variables and strokestatus.
RESULTS:
LowernadirPaO2 values were associated with postoperative stroke, with estimated odds of stroke increasing over 20% (adjusted odds ratio [OR],1.23; 95% confidence interval [CI],1.07-1.41) per 10 mm Hg lower nadir PaO2, and similarly increased odds ofstroke per lower quartile of nadir PaO2(OR,1.60;95%CI,1.19-2.16).When average PaO2 was considered,odds of stroke was alsoincreased(adjusted OR, 1.39 per lower quartile of mean PaO2;95% CI,1.05-1.83).Having a nadir PaO2 value in the lowest versus any other quartile was associated with an estimated 2.41-fold increased odds of stroke(95% CI,1.22-4.78). Quartile of nadir but not average PaO2 results remained significant after adjustment for multiple comparisons.
CONCLUSIONS:
Oddsof stroke after cardiac surgery are increased in patients with a low minimum PaO2 within 24 hours of surgery. Results should be validated in an independent cohort. Further characterizing the underlying etiology of hypoxic episodes will be important to improve patient outcomes.
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