【原】【罂粟摘要】氧储备指数在单肺通气中的应用及其对外周血氧饱和度、灌注指数和脉搏灌注变异指数的影响

氧储备指数在单肺通气中的应用及其对外周血氧饱和度、灌注指数和脉搏灌注变异指数的影响

贵州医科大学 麻醉与心脏电生理课题组

翻译：吴学艳    编辑：张中伟    审校：曹莹

背景

研究目的是探讨在单肺通气(OLV)过程中，用氧储备指数(ORi)检测低氧血症及其与外周血氧饱和度、灌注指数(PI)和脉搏灌注变异指数(PVI)等参数的关系。

方法

研究共纳入50例在全身麻醉和OLV下行择期胸部手术的患者，该项观察性队列研究在一家三甲教学医院进行，所有患者插入左双腔管后行OLV。OLV期间低氧血症定义为吸入氧浓度(FiO2)高于50%，外周血氧饱和度(SpO2)仍低于95%。连续测定ORi、脉搏血氧饱和度、PI和PVI值。计算手术中不同时间段ORi值为零的灵敏度、特异度、阳性预测值和阴性预测值、似然比和准确性，以预测低氧血症的发生。已在Clinicaltrials.gov中心注册，注册ID为NCT05050552。

结果

19例(38%)患者出现低氧血症；在仰卧位插管后5min(DS5)，ORi值为0时预测低氧血症的准确性；显示敏感性为92.3%(95%CI 84.9-99.6)，特异性为81.1%(95%CI 70.2-91.9)，准确性为84.0%(95%CI 73.8-94.2)。为了预测低氧血症的准确性，ORi为0时在DS5至OLV30的时间段显示具有良好的敏感性、特异性和统计准确性，其敏感性为43.8%，特异性为64%，准确性为56.1%。ORi和SpO2与DS5、侧卧位双肺通气后5 min(DL5)和OLV后10 min (OLV10)存在相关性(p=0.044,p=0.039,p=0.011)；时间相关性分析还表明，在DS5时间段，ORi与PI呈显著负相关，而与PVI无相关性。

结论

在胸部手术中，从插管后5min(DS5)到OLV后30min，ORi为预测吸入氧浓度(FiO2)>50%、SpO2<95%的低氧血症提供了有价值的信息。

原始文献来源

         Sagiroglu G, Baysal A, Karamustafaoglu YA. The use of oxygen reserve index in one-lung ventilation and its impact on peripheral oxygen saturation, perfusion index and, pleth variability index[J]. BMC Anesthesiol. 2021 Dec 20;21(1):319. DOI:10.1186/s12871-021-01539-8.

英文原文

The use of oxygen reserve index in one-lung ventilation and its impact on peripheral oxygen saturation, perfusion index and, pleth variability index

Background

 Our goal is to investigate the use of the oxygen reserve index (ORi) to detect hypoxemia and its relation with parameters such as; peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV).

Methods

Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. All patients required OLV after a left-sided double-lumen tube insertion during intubation. The definition of hypoxemia during OLV is a peripheral oxygen saturation (SpO2) value of less than 95%, while the inspired oxygen fraction (FiO2) is higher than 50% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI values were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi values equal to zero in different time points during surgery to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552.

Results

Hypoxemia was observed in 19 patients (38%). The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at 5 min after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9-99.6), specificity of 81.1% (95% CI 70.2-91.9), and an accuracy of 84.0% (95% CI 73.8-94.2). For predicting hypoxemia, ORi equals zero show good sensitivity, specificity, and statistical accuracy values for time points of DS5 until OLV30 where the sensitivity of 43.8%, specificity of 64%, and an accuracy of 56.1% were recorded. ORi and SpO2 correlation was found at DS5, 5 min after lateral position with two-lung ventilation (DL5) and at 10 min after OLV (OLV10) (p = 0.044, p = 0.039, p = 0.011, respectively). Time-dependent correlations also showed that; at a time point of DS5, ORi has a significant negative correlation with PI whereas, no correlations with PVI were noted.

Conclusions

During the use of OLV for thoracic surgeries, from 5 min after intubation (DS5) up to 30 min after the start of OLV, ORi provides valuable information in predicting hypoxemia defined as SpO2 less than 95% on pulse oximeter at FiO2 higher than 50%.

有江湖的地方就有人！

谢谢您的点赞、分享、在看，

欢迎你的精彩评论哦

END