全身麻醉颈椎术后患者早期低氧血症发生与改善情况及其相关因素分析  

Incidence and improvement of early-stage hypoxemia after cervical spine surgery under general anesthesia and their relevant factors

作　　者：陈坤 戴建强 蔡学究 张亮达 黄显华 CHEN Kun;DAI Jian-qiang;CAI Xue-jiu;ZHANG Liang-da;HUANG Xian-hua(Orthopedics Intensive Care Unit,General Hospital of Southern TheateRCommand of Chinese People′s Liberation Army,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院骨科重症监护室,广东省广州市510010

出　　处：《广西医学》2020年第3期258-263,共6页Guangxi Medical Journal

基　　金：广东省广州市科技计划(201804010330)。

摘　　要：目的探讨全身麻醉颈椎术后患者早期低氧血症发生情况与改善情况及其相关因素。方法纳入采用全身麻醉行择期颈椎手术治疗的95例患者,依据术后1 h内的氧合指数评估患者术后早期低氧血症发生情况。比较低氧血症患者(低氧血症组)和无低氧血症患者(对照组)患者的基线资料和围术期指标,并分析全身麻醉颈椎术后患者早期发生低氧血症的危险因素。观察低氧血症患者术后第2天氧合指数改善情况,比较改善者和无改善者的基线资料及围术期相关指标,并分析围术期液体管理与低氧血症改善情况的关系。结果术后1 h内共23例(24.2%)患者出现低氧血症;合并糖尿病和创伤性颈髓损伤是患者术后1 h发生低氧血症的危险因素(均P<0.05);低氧血症组的住院费用为高于对照组(P<0.05)。23例低氧血症患者中,共8例患者术后第2天氧合指数改善;与氧合指数未改善者比较,氧合指数改善者的体质指数更低,手术时间及术后鼻氧管给氧时间更短,术后12 h补液量更少(均P<0.05)。结论全身麻醉下行择期颈椎手术的患者在术后1 h可出现低氧血症,其中合并糖尿病和创伤性颈髓损伤的患者更易发生低氧血症;手术时间短、体质指数低的患者低氧血症易改善,早期减少补液或有利于低氧血症的改善。Objective To explore the incidence and improvement of early-stage hypoxemia afteRcervical spine surgery undeRgeneral anesthesia and theiR relevant factors.Methods Ninety-five patients afteRselective cervical spinal surgery undeRgeneral anesthesia were enrolled,and the incidence of hypoxemia in early stage postoperatively was assessed according to oxygenation index within 1 houRafteRoperation.The baseline data and perioperative indexes were compared between patients with hypoxemia and without hypoxemia(hypoxemia group and control group,respectively),and the risk factors foRdeveloping hypoxemia afteRcervical spine surgery undeRgeneral anesthesia in early stage were analyzed.The improvement of oxygenation index of patients with hypoxemia was observed on the second day afteRoperation,and the baseline data and perioperative relevant indexes were compared between patients with and without improvement;besides,the relation of perioperative fluid management with hypoxemia improvement was analyzed.Results Totally 23(24.2%)patients suffered from hypoxemia within 1 houRafteRoperation;diabetes and traumatic cervical spinal cord injury were the risk factors foRdeveloping hypoxemia within 1 houRafteRoperation(all P<0.05);the hospital cost of the hypoxemia group was more than that of the control group(P<0.05).Of the 23 patients with hypoxemia,8 patients obtained improvement in oxygenation index on the second day afteRoperation;in comparison with patients with non-improved oxygenation index,patients with improved oxygenation index processed loweRbody mass index,shorteRdurations of operation and postoperative nasal catheteRoxygen inhalation,as well as less postoperative 12-houRfluid infusion(all P<0.05).Conclusion Patients undergoing selective cervical spine surgery undeRgeneral anesthesia might suffeRfrom hypoxemia 1 houR postoperatively,among whom patients complicated with diabetes oRdiagnosed as traumatic cervical spinal cord injury are prone to hypoxemia;hypoxemia is alleviated more easily in patients with shorteRoperation dur

关 键 词：低氧血症 全身麻醉 颈椎手术 择期手术 术后 早期 危险因素 改善 

分 类 号：R614.2[医药卫生—麻醉学]