围术期高浓度氧气吸入对减少外科感染的作用：一项荟萃分析  

作　　者：Brandon Togioka, MD Samuel Galvagno, DO Shawn Sumida, MD Jamie Murphy, MD Jean-Pierre Ouanes, DO Christopher Wu, MD 武林鑫(译) 黄雄庆(校) 陈秉学(校) 

机构地区：[1]Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland [2]不详

出　　处：《麻醉与镇痛》2013年第5期22-30,共9页Anesthesia & Analgesia

摘　　要：背景目前，高浓度氧气吸入对于预防外科手术部位感染的临床作用尚不清楚，主要由于该领域中随机对照试验的结论并不一致。本系统性回顾的目的在于探讨围术期高浓度氧气吸入能否降低手术切口感染的风险。方法2010年7月12日，我们针对国家医学图书馆Medline数据库（见附录1）、Cochrane中心CENTRAL数据库、EMBASE数据库资料进行了电子检索，入选评估成年患者围术期感染的随机、对照研究，要求文献中包含高浓度氧气吸入组与低浓度吸氧组或对照组的比较。我们主要研究结果（外科感染）是汇总资料比值比的95％可信区间，应用CochraneCollaboration’SRevMan5．0．25版本软件（CochraneCollaboration，Oxford，UK），并采用随机效应模型进行计算。结果文献检索最终入选包含2728例患者的7个临床试验，随机分为高氧组1358例，对照组1370例。高氧组总感染率为15．5％，对照组为17．5％。高氧组术野感染率的比值比为0．85（95％可信区间为0．52，1．38）（P=0．51）。但2个亚组（全麻和结直肠手术亚组）的分析结果显示，高浓度氧气吸入有助干减少手术切口感染。结论基于本荟萃分析，总体来看围术期吸入高浓度氧并不能预防切口感染。但2个亚组（全麻和结直肠手术亚组）的阳性结果表明，高浓度氧可降低围术期切口感染的发生率。目前，仍需进一步的研究对高浓度吸氧的作用加以探讨。BACKGROUND： The clinical role of hyperoxia for preventing surgical site infection remains uncertain because randomized controlled trials on this topic have reported disparate results. Our objective in this systematic review was to determine whether perioperative hyperoxia reduces surgical site infection. METHODS： An electronic search was conducted using the National Library of Medicine＇s MEDLINE, Cochrane Collaboration＇s CENTRAL, and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of high oxygen versus low oxygen or control, and with a documented assessment for perioperative infection. Pooled estimates for odds ratios （ORs） with 95 % confidence intervals were obtained for our primary outcome （surgical site infection） using the Cochrane Collaboration＇s RevMan version 5.0.25 （Cochrane Collaboration, Oxford, UI（）. ORs were calculated using a random effects model. RESULTS： The literature search ultimately yielded 7 trials, enrolling 2728 patients, that were included in the analysis. There were 1358 patients randomly assigned to hyperoxia and 1370 to control. The pooled infection rate in the hyperoxia group was 15.5% versus 17.5% in the control group. Hyperoxia resulted in an OR of 0.85 for surgical site infection （95% confidence interval： 0.52, 1.38） （P =0.51 ）. However, 2 subgroup analyses （general anesthesia and colorectal surgery trials） showed a benefit for high inspired oxygen therapy of decreasing surgical site infection. CONCLUSIONS： Perioperative high inspired oxygen therapy overall was not found to be beneficial for preventing surgical site infection based on this meta-analysis. The positive results of 2 subgroup analyses （general anesthesia and colorectal surgery trials） suggest a benefit for hyperoxia in decreasing surgical site infection. Additional studies are needed to further investigate this intervention.

关 键 词：高浓度氧气吸入 外科感染 荟萃分析 围术期 MEDLINE数据库 COCHRANE中心 手术切口感染 随机对照试验 

分 类 号：R605.973[医药卫生—急诊医学]