【原】【罂粟摘要】麻醉恢复期和术后低氧血症期间的半卧位

麻醉恢复期和术后低氧血症期间的半卧位

贵州医科大学  麻醉与心脏电生理课题组

翻译：周倩   编辑：周倩   审校：曹莹

背景

尽管半卧位(SRP)被广泛使用在麻醉苏醒期，但是其对减少术后低氧血症的效果尚不清楚。本研究拟确定半卧位和仰卧位患者术后低氧血症的差异。

方法

这项随机临床试验于2021年3月20日至2022年5月10日在中国一家三级医院进行。计划在全身麻醉下进行腹腔镜上腹部手术的患者被纳入研究。研究招募和随访已完成。患者在手术结束时被随机分配到以下三组，直到离开麻醉后监护病房:仰卧位(S组)、15° SRP(F组)或30° SRP(T组)。主要结局指标是麻醉后恢复室术后低氧血症的发生率。还评估了严重低氧血症的发生率。

结果 

在700名患者中（364名男性[52.0%]；平均年龄47.8岁，SD[11.3]）、233名患者被随机分为S组（126名男性[54.1%]；平均年龄48.2岁，SD[10.9]）、233名患者分为F组（122名男性[52.4%]；平均年龄48.1岁，SD[10.9]）和234名患者分到T组（118名女性[50.4%]；平均年龄47.2岁,SD[12.1]）。术后低氧血症在3组之间存在显著差异（S组，233人中有109人[46.8%]；F组，233人为105人[45.1%]；T组，234人为76人[32.5%]；P =0 .002)；T组与S组的差异具有统计学意义（RR，0.69[95%CI，0.55-0.87]；P =0 .002) ；T组与F组（RR，0.72[95%CI，0.57-0.91]；P =0 .007)；但F组与S组无显著差异（RR，0.96[95%CI，0.79-1.17]；P =0 .78)。严重低氧血症在3组之间也存在差异（S组，233人中有61人[26.2%]；F组，233人为53人[22.7%]；T组，234人为36人[15.4%]；P = 0.01)。T组与S组的差异具有统计学意义（RR，0.59[95%CI，0.41-0.85]；P =0 .005)。

 结论 

在这项腹腔镜上腹部手术患者麻醉恢复期间半卧位的随机临床试验中，与F组或S组相比，T组术后低氧血症显著减少。

原始文献：Xinghe, Wang,Kedi, Guo,Jia, Sun et al. Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia: A Randomized Clinical Trial.[J] .JAMA Netw Open, 2024Jun28;7(6):e2416797.

doi:10.1001/jamanetworkopen.2024.16797

Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia

Importance

The efficacy of a semirecumbent position (SRP) in reducing postoperative hypoxemia during anesthesia emergence is unclear despite its widespread use.

Objective

To determine the differences in postoperative hypoxemia between patients in an SRP and a supine position.

Design, Setting, and Participants

This randomized clinical trial was performed at a tertiary hospital in China between March 20, 2021, and May 10, 2022. Patients scheduled to undergo laparoscopic upper abdominal surgery under general anesthesia were enrolled. Study recruitment and follow-up are complete.

Interventions

Patients were randomized to 1 of the following positions at the end of the operation until leaving the postanesthesia care unit: supine (group S), 15° SRP (group F), or 30° SRP (group T).

Main Outcomes and Measures

The primary outcome was the incidence of postoperative hypoxemia in the postanesthesia care unit. Severe hypoxemia was also evaluated.

Results

Out of 700 patients (364 men [52.0%]; mean [SD] age, 47.8 [11.3] years), 233 were randomized to group S (126 men [54.1%]; mean [SD] age, 48.2 [10.9] years), 233 to group F (122 men [52.4%]; mean [SD] age, 48.1 [10.9] years), and 234 to group T (118 women [50.4%]; mean [SD] age, 47.2 [12.1] years). Postoperative hypoxemia differed significantly among the 3 groups (group S, 109 of 233 [46.8%]; group F, 105 of 233 [45.1%]; group T, 76 of 234 [32.5%]; P = .002). This difference was statistically significant for groups T vs S (risk ratio [RR], 0.69 [95% CI, 0.55-0.87]; P = .002) and groups T vs F (RR, 0.72 [95% CI, 0.57-0.91]; P = .007), but not for groups F vs S (RR, 0.96 [95% CI, 0.79-1.17]; P = .78). Severe hypoxemia also differed among the 3 groups (group S, 61 of 233 [26.2%]; group F, 53 of 233 [22.7%]; group T, 36 of 234 [15.4%]; P = .01). This difference was statistically significant for groups T vs S (RR, 0.59 [95% CI, 0.41-0.85]; P = .005).

Conclusions and Relevance

In this randomized clinical trial of SRP during anesthesia recovery in patients undergoing laparoscopic upper abdominal surgery, postoperative hypoxemia was significantly reduced in group T compared with group F or group S.

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