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体外循环期间动脉高氧血症与术后肺功能恶化无关：一项回顾性队列研究
贵州医科大学 麻醉与电生理课题组 翻译：陈锐 编辑：杨荣峰 审校：曹莹 动脉高氧血症可引起继发于自由基形成增加的终末器官损伤。关于体外循环(CPB)手术中动脉高氧血症术后肺毒性的临床证据很少，心脏手术中动脉氧分压(PaO2 )对肺损伤的影响尚未得到充分研究。因此，我们旨在研究CPB期间PaO2与术后肺损伤的关系。其次，我们研究了PaO2与整体(乳酸)和局部组织灌注不良(急性肾损伤)之间的关系。我们通过检测心肌(肌钙蛋白)和肝损伤(胆红素)标志物进一步探讨了与局部组织灌注不良的关系。 这是一项回顾性队列研究，包括2015年4月至2021年12月期间在一家大型四级医疗中心接受需要CPB的择期心脏手术（冠状动脉搭桥术、瓣膜手术、主动脉手术或联合手术）的患者。主要结局是术后肺功能，定义为PaO2与吸入氧浓度分数（FiO2）的比值;手术后6小时或拔管前的P/F比。使用线性或逻辑回归模型评估CPB在线样本监测仪PaO2与主要、次要和探索性结果之间的关联，并调整可用的基线混杂因素。 共有9141例患者符合纳入和排除标准，8429例（92.2%）患者具有完整的基线变量并纳入分析。样本的平均年龄为64岁（SD=13），68%为男性（n=6208）。CPB期间在线样品监测仪PaO2的时间加权平均值（TWA）与术后P/F比值呈弱正相关。随着PaO2增加100个单位，术后P/F比值的估计增加为4.61（95%CI，0.71-8.50;P=0.02）。我们的二次分析显示，PaO2与CPB后6小时乳酸峰值之间没有显著关联（几何平均比[GMR]，1.01;98.3%CI，0.98-1.03;P=0.55），CPB后6小时平均乳酸（GMR，1.00;98.3%CI，0.97-1.03;P=0.93），或肾病改善全球结局（KDIGO）标准（比值比，0.91;98.3%CI，0.75-1.10;P=0.23）。
我们的研究发现，CPB期间的PaO2与术后肺功能之间没有临床显着关联。同样，CPB期间的PaO2与乳酸水平、术后肾功能或其他探索性结局之间没有关联。 原始文献来源：Kelava, M., Milam, A. J., Mi, J., Alfirevic, A., Grady, P., Unai, S., Elgharably, H., McCurry, K., Koprivanac, M., & Duncan, A. (2024). Arterial Hyperoxemia During Cardiopulmonary Bypass Was Not Associated With Worse Postoperative Pulmonary Function: A Retrospective Cohort Study. Anesthesia and analgesia, 138(5), 1003–1010. https:///10.1213/ANE.0000000000006627 英文原文 Arterial Hyperoxemia During Cardiopulmonary Bypass Was Not Associated With Worse Postoperative Pulmonary Function: A Retrospective Cohort Study Abstract Background: Arterial hyperoxemia may cause end-organ damage secondary to the increased formation of free oxygen radicals. The clinical evidence on postoperative lung toxicity from arterial hyperoxemia during cardiopulmonary bypass (CPB) is scarce, and the effect of arterial partial pressure of oxygen (PaO2) during cardiac surgery on lung injury has been underinvestigated. Thus, we aimed to examine the relationship between PaO2 during CPB and postoperative lung injury. Secondarily, we examined the relationship between PaO2 and global (lactate), and regional tissue malperfusion (acute kidney injury). We further explored the association with regional tissue malperfusion by examining markers of cardiac (troponin) and liver injury (bilirubin). Methods: This was a retrospective cohort study including patients who underwent elective cardiac surgeries (coronary artery bypass, valve, aortic, or combined) requiring CPB between April 2015 and December 2021 at a large quaternary medical center. The primary outcome was postoperative lung function defined as the ratio of PaO2 to fractional inspired oxygen concentration (FiO2); P/F ratio 6 hours following surgery or before extubation. The association between CPB in-line sample monitor PaO2 and primary, secondary, and exploratory outcomes was evaluated using linear or logistic regression models adjusting for available baseline confounders. Results: A total of 9141 patients met inclusion and exclusion criteria, and 8429 (92.2%) patients had complete baseline variables available and were included in the analysis. The mean age of the sample was 64 (SD = 13), and 68% were men (n = 6208). The time-weighted average (TWA) of in-line sample monitor PaO2 during CPB was weakly positively associated with the postoperative P/F ratio. With a 100-unit increase in PaO2 , the estimated increase in postoperative P/F ratio was 4.61 (95% CI, 0.71-8.50; P = .02). Our secondary analysis showed no significant association between PaO2 with peak lactate 6 hours post CPB (geometric mean ratio [GMR], 1.01; 98.3% CI, 0.98-1.03; P = .55), average lactate 6 hours post CPB (GMR, 1.00; 98.3% CI, 0.97-1.03; P = .93), or acute kidney injury by Kidney Disease Improving Global Outcomes (KDIGO) criteria (odds ratio, 0.91; 98.3% CI, 0.75-1.10; P = .23). Conclusions: Our investigation found no clinically significant association between PaO2 during CPB and postoperative lung function. Similarly, there was no association between PaO2 during CPB and lactate levels, postoperative renal function, or other exploratory outcomes. |
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