目的:急诊外科手术涉及相当大的风险。其中,术后早期低氧血症(EPH)是麻醉后监护病房(PACU)常见的麻醉并发症.卫生专业人员对EPH非常关注,具体来说,那些在夜间提供紧急手术的人。这增加了与麻醉结束时间相关的EPH风险问题。因此,本研究旨在确定在全身麻醉下接受急诊手术的成年患者的EPH程度及其相关因素.
方法:通过连续采样技术进行前瞻性观察研究。采用二元Logistic回归分析确定相关危险因素。将在双变量分析中发现有统计学意义的所有变量输入到多变量逻辑回归分析中。
结果:在352名接受急诊手术的患者中,149例(42.3%)患者发生了EPH。与EPH显著相关的因素是夜间麻醉结束(AOR=1.76,95CI[1.01,3.05],p=0.045),ASAIII(AOR=12.35,95CI:[4.5,34.02],p≤0.001),年龄大于55岁(AOR=3.2,95CI:[1.7,5.91],p≤0.001),手术持续时间大于2小时(AOR=2.012,95CI:[1.2,3.51],p=0.014),低血压(AOR=10.3,95CI:[2.4,44.16],p=0.002),肌肉力量评分为零(AOR=2.944,95CI:[1.8,4.82],p≤0.001),术前氧饱和度低于95%(AOR=2.371,95CI:[1.35,4.16],p=0.003)。
结论:急诊手术患者的EPH程度较高,因此建议应及时提供氧气以减少EPH。确定的危险因素是夜间结束麻醉,ASAIII,年龄大于55,手术持续时间大于2小时,低血压,肌肉力量得分为零,术前氧饱和度低于95%。这项研究发现,在清晨结束麻醉有利于清晨早期术后低氧血症(EMEPH)。为了避免EMEPH,麻醉师应避免有利于肺部早间麻醉增强EPH昼夜节律的因素。
OBJECTIVE: Emergency surgical procedures involve considerable risks. Among these, early postoperative hypoxemia (
EPH) is a frequent anesthetic complication in the post-anesthetic care unit (PACU). There is a great concern for
EPH among health professionals, specifically, those providing emergency surgery during the nighttime. This raised anesthesia-ended time-related risk of
EPH question. Thus, this study aimed to determine the magnitude of
EPH and its associated factors among adult patients who undergo emergency surgery under general anesthesia.
METHODS: A prospective observational study through a consecutive sampling technique was conducted. Binary logistic regression analysis was used to identify associated risk factors. All variables that were found statistically significant on bivariable analysis were entered into a multivariable logistic regression analysis.
RESULTS: Of 352 patients who had undergone emergency surgery, 149 (42.3%) patients developed EPH. Factors significantly associated with
EPH were anesthesia ended during nighttime (AOR = 1.76, 95%CI [1.01, 3.05], p = 0.045), ASA III (AOR = 12.35, 95%CI: [4.5, 34.02], p ≤ 0.001), age greater than 55 (AOR = 3.2, 95%CI: [1.7, 5.91], p ≤ 0.001), surgery duration greater than 2 h (AOR = 2.012, 95%CI: [1.2, 3.51], p = 0.014), hypotension (AOR = 10.3, 95%CI: [2.4, 44.16], p = 0.002), muscular strength score zero (AOR = 2.944, 95%CI: [1.8, 4.82], p ≤ 0.001), and preoperative oxygen saturation less than 95% (AOR = 2.371, 95%CI: [1.35,4.16], p = 0.003).
CONCLUSIONS: The magnitude of EPH among patients who have undergone emergency surgery was high and thus recommended that oxygen should be provided timely to decrease it. Identified risk factors were night-time ended anesthesia, ASA III, age greater than 55, surgery duration greater than 2 h, hypotension, muscular strength score zero, and preoperative oxygen saturation less than 95%. This study found anesthesia ended during early morning favors early morning early postoperative hypoxemia (EMEPH). To avert EMEPH, the anesthetist should avoid factors that favor the circadian rhythm of the lung-based early morning anesthesia augmented EPH.