西藏高海拔地区人群非心胸外科手术术中低氧血症的危险因素：前瞻性队列研究

段函宇; 朱倩梅; 次仁德吉; 李艺; 苗煦涵; 张越伦; 刘子嘉; 拉巴次仁; 申乐; 黄宇光

doi:10.12290/xhyxzz.2022-0610

西藏高海拔地区人群非心胸外科手术术中低氧血症的危险因素：前瞻性队列研究

Risk Factors of Hypoxemia During Non-cardiothoracic Surgery for Populations at High Altitude in Tibet: A Prospective Cohort Study

摘要

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.

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