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Risk Factors of Hypoxemia During Non-cardiothoracic Surgery for Populations at High Altitude in Tibet: A Prospective Cohort Study
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摘要:
目的 探讨西藏高海拔地区人群行全身麻醉非心胸外科手术术中低氧血症发生率及其危险因素，并简要分析术中低氧血症对患者预后的影响。 方法 前瞻性收集2021年6月1日至2022年8月31日西藏自治区人民医院行全身麻醉非心胸外科手术患者的临床资料，包括术前基本资料、手术及麻醉相关信息，主要结局指标为术中低氧血症。采用多因素Logistic回归法分析术中低氧血症的危险因素，并比较术中低氧血症与非术中低氧血症患者围术期预后指标差异。 结果 共入选符合纳入与排除标准的全身麻醉非心胸外科手术患者161例。其中发生术中低氧血症9例(5.6%)，非术中低氧血症152例(94.4%)。多因素Logistic回归分析结果显示，术前血氧饱和度≤85%(OR=4.604, 95% CI: 1.064~19.916, P=0.041)、术前血红蛋白≥170 g/L(OR=5.396, 95% CI: 1.163~25.035, P=0.031)、术前肺动脉压≥40 mm Hg(OR=11.744, 95% CI: 1.599~86.243, P=0.015)是西藏高海拔地区人群行全身麻醉非心胸外科手术出现术中低氧血症的独立危险因素。术中低氧血症患者围术期心脏不良事件发生率较非术中低氧血症患者显著增加(55.6%比15.1%，P=0.002)。 结论 术前低血氧饱和度、高血红蛋白血症和肺动脉高压是西藏高海拔地区人群行全身麻醉非心胸外科手术术中低氧血症的危险因素，且术中低氧血症可能对患者预后造成不良影响。 Abstract:Objective To investigate the incidence and risk factors of intraoperative hypoxemia in non- cardiothoracic surgery under general anesthesia in high-altitude areas of Tibet, and briefly analyze the impact of intraoperative hypoxemia on the prognosis. Methods The clinical data of patients undergoing non-cardiothoracic surgery under general anesthesia in Tibet Autonomous Region People's Hospital from June 1, 2021 to August 31, 2022 were collected prospectively, including basic preoperative data, surgery information and anesthesia management. The main outcome was intraoperative hypoxemia. Multivariate Logistic regression was used to analyze the risk factors of intraoperative hypoxemia. The perioperative prognosis of patients with or without intraoperative hypoxemia was compared. Results A total of 161 patients having non-cardiothoracic surgery under general anesthesia who met the inclusion and exclusion criteria were included. Among them, 9 patients (5.6%) suffered intraoperative hypoxemia and 152 cases (94.4%) experienced non-intraoperative hypoxemia. Multivariate Logistic regression analysis showed that preoperative oxygen saturation ≤ 85%(OR=4.604, 95% CI: 1.064-19.916, P=0.041), preoperative hemoglobin ≥ 170 g/L (OR=5.396, 95% CI: 1.163-25.035, P=0.031), and preoperative pulmonary artery pressure ≥ 40 mm Hg (OR=11.744, 95% CI: 1.599-86.243, P=0.015) were independent risk factors for hypoxemia during non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet. The incidence of perioperative adverse cardiac events in patients with intraoperative hypoxemia was significantly higher than that in patients without intraoperative hypoxemia (55.6% vs. 15.1%, P=0.002). Conclusion Preoperative low oxygen saturation, hyperhemoglobin and pulmonary hypertension are the risk factors of intraoperative hypoxemia in non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet, and intraoperative hypoxemia may have a negative impact on the prognosis of patients. -
Key words:
- Tibet autonomous region /
- high altitude /
- general anesthesia /
- intraoperative hypoxemia /
- risk factor
作者贡献：段函宇、次仁德吉、苗煦涵负责数据收集；朱倩梅、李艺、张越伦、刘子嘉负责数据处理与统计分析、论文撰写；段函宇、刘子嘉、拉巴次仁、申乐、黄宇光负责研究设计及论文修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 161例行全身麻醉非心胸外科手术患者的临床资料
指标 数值 男性[n(%)] 71(44.1) 年龄[M(P25, P75), 岁] 59(54，65) 藏族[n(%)] 153(95.0) 吸烟史[n(%)] 29(18.0) 目前吸烟[n(%)] 15(9.3) 居住地海拔[n(%)] 3000~＜3500 m 15(9.3) 3500~＜4000 m 75(46.6) 4000~＜4500 m 62(38.5) 4500~＜5000 m 7(4.3) ≥5000 m 2(1.2) 手术类别[n(%)] 神经外科手术 14(8.7) 腹腔和腹膜后手术 57(35.4) 血管外科手术 10(6.2) 骨科手术 29(18.0) 泌尿外科手术 26(16.1) 头颈外科手术 19(11.8) 其他手术 6(3.7) 术前SpO2[M(P25, P75), %] 82(79.25, 86.25) 术前Hb[M(P25, P75), g/L] 164 (133.5, 190.5) 术中低氧血症[n(%)] 9(5.6) SpO2：血氧饱和度；Hb：血红蛋白 
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表 2 术中低氧血症与非术中低氧血症患者临床资料比较
指标 术中低氧血症患者(n=9) 非术中低氧血症患者(n=152) P值 年龄＞65岁[n(%)] 4(44.4) 31(20.4) 0.199 男性[n(%)] 5(55.6) 66(43.4) 0.714 BMI [M(P25, P75), kg/m2] 24.9(22.6, 27.0) 24.6(21.7, 27.6) 0.771 ASA分级[n(%)] 0.758 Ⅰ~Ⅱ 5(55.6) 101(66.4) Ⅲ~Ⅳ 4(44.4) 51(33.6) 吸烟史[n(%)] 2(22.2) 27(17.8) ＞0.999 高血压史[n(%)] 7(77.8) 69(45.4) 0.122 哮喘史[n(%)] 1(11.1) 4(2.6) 0.663 COPD史[n(%)] 6(66.7) 53(34.9) 0.117 术前SpO2≤85%[n(%)] 5(55.6) 28(18.4) 0.024 术前Hb≥170 g/L[n(%)] 5(55.6) 30(19.7) 0.034 术前肺动脉压≥40 mm Hg[n(%)] 2(22.2) 6(3.9) 0.096 吸入麻醉药[n(%)] 5(55.6) 129(84.9) 0.068 BMI：体质量指数；ASA：美国麻醉医师协会；COPD：慢性阻塞性肺疾病；SpO2、Hb：同表 1
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表 3 全身麻醉非心胸外科手术术中低氧血症危险因素的多因素Logistic回归分析结果
指标 β值 SE Wald OR(95% CI) P值 术前SpO2≤85% 1.527 0.747 4.175 4.604(1.064~19.916) 0.041 术前Hb≥170 g/L 1.686 0.783 4.634 5.396(1.163~25.035) 0.031 术前肺动脉压≥40 mm Hg 2.463 1.017 5.864 11.744(1.599~86.243) 0.015 SpO2、Hb：同表 1
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表 4 术中低氧血症与非术中低氧血症患者预后指标比较
指标 术中低氧血症患者(n=9) 非术中低氧血症患者(n=152) P值 围术期心脏不良事件[n(%)] 5(55.6) 23(15.1) 0.002 非心脏术后并发症[n(%)] 0(0) 3(2.0) 0.841 术后转入ICU [n(%)] 1(11.1) 4(2.6) 0.154 术后住院时间[M(P25, P75), d] 4(3, 9) 7(5, 12) 0.439 总住院时间[M(P25, P75), d] 11(6, 14) 14(9, 20) 0.246
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