Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection
Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection
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DOI：
10.1056/nejm200001203420303
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发表时间：
2000-01-20
影响因子：
158.5
通讯作者：
Sessler, DI
中科院分区：
文献类型：
--
作者：
Greif, R;Akça, O;Sessler, DI
背景氧化破坏或氧化杀灭是对抗外科病原体的最重要防御措施，取决于受污染组织中的氧分压。提高充分灌注组织中氧分压的一种简单方法是增加吸入氧的浓度。因此，我们测试的假设，即在围手术期的补充管理氧气减少伤口infection.Methods的发病率，我们随机分配500例接受结肠直肠切除术，以获得30%或80%的吸入氧气在操作过程中，两个小时后。所有患者均接受了预防性抗生素治疗。使用双盲方案，每天评估伤口，直到患者出院，然后在手术后两周进行诊所访视。我们认为脓液培养阳性的伤口是感染。缝线拆除的时间和出院的日期由外科医生，谁不知道病人的治疗组assignment.Results动脉血氧饱和度是正常的，在这两组，但是，动脉和皮下氧分压显着较高的患者给予80%的氧气比那些给予30%的氧气。在接受80%氧气的250名患者中，有13名（5.2%; 95%置信区间，2.4%至8.0%）发生了伤口感染，而在接受30%氧气的250名患者中有28名（11.2%; 95%置信区间，7.3%至15.1%; P=0.01）。两组之间的绝对差异为6.0%（95%置信区间为1.2%至10.8%）。结论围手术期辅助给氧是降低手术切口感染发生率的有效方法。（新英格兰医学杂志2000;342：161-7。）(C)2000年，马萨诸塞州医学会。
Background Destruction by oxidation, or oxidative killing, is the most important defense against surgical pathogens and depends on the partial pressure of oxygen in contaminated tissue. An easy method of improving oxygen tension in adequately perfused tissue is to increase the concentration of inspired oxygen. We therefore tested the hypothesis that the supplemental administration of oxygen during the perioperative period decreases the incidence of wound infection.Methods We randomly assigned 500 patients undergoing colorectal resection to receive 30 percent or 80 percent inspired oxygen during the operation and for two hours afterward. Anesthetic treatment was standardized, and all patients received prophylactic antibiotic therapy. With use of a double-blind protocol, wounds were evaluated daily until the patient was discharged and then at a clinic visit two weeks after surgery. We considered wounds with culture-positive pus to be infected. The timing of suture removal and the date of discharge were determined by the surgeon, who did not know the patient's treatment-group assignment.Results Arterial oxygen saturation was normal in both groups; however, the arterial and subcutaneous partial pressure of oxygen was significantly higher in the patients given 80 percent oxygen than in those given 30 percent oxygen. Among the 250 patients who received 80 percent oxygen, 13 (5.2 percent; 95 percent confidence interval, 2.4 to 8.0 percent) had surgical-wound infections, as compared with 28 of the 250 patients given 30 percent oxygen (11.2 percent; 95 percent confidence interval, 7.3 to 15.1 percent; P=0.01). The absolute difference between groups was 6.0 percent (95 percent confidence interval, 1.2 to 10.8 percent). The duration of hospitalization was similar in the two groups.Conclusions The perioperative administration of supplemental oxygen is a practical method of reducing the incidence of surgical-wound infections. (N Engl J Med 2000;342:161-7.) (C) 2000, Massachusetts Medical Society.