Obesity decreases perioperative tissue oxygenation
Obesity decreases perioperative tissue oxygenation
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DOI：
10.1097/00000542-200402000-00015
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发表时间：
2004-02-01
期刊：
影响因子：
8.8
通讯作者：
Kurz, A
中科院分区：
文献类型：
--
作者：
Kabon, B;Nagele, A;Kurz, A
背景：肥胖是手术部位感染的重要危险因素。手术伤口感染的发生与组织灌注和氧合直接相关。脂肪组织质量扩张，但每个细胞的血液流量并未随之增加，这可能导致相对灌注不足，组织氧合作用减少。因此，作者测试了肥胖手术患者围手术期组织氧张力降低的假设。此外，他们还比较了补充供氧对肥胖和非肥胖患者组织氧合的影响。 方法：46 名接受腹部大手术的患者根据体重指数被分配到两组中的一组：体重指数小于 30 kg/m(2)（非肥胖）或 30 kg/m(2) 或更大（肥胖）。术中供氧按随机顺序调整至约 150 mmHg 和约 300 mmHg 的动脉氧压。麻醉技术和围手术期液体管理已标准化。在手术期间、恢复室和术后第一天，使用位于上臂外侧皮下眼压计内的极谱电极测量皮下组织氧张力。还测量了伤口附近的术后组织氧。数据采用不配对双尾t检验和Wilcoxon秩和检验进行比较； P < 0.05 被认为具有统计学意义。 结果：肥胖患者的术中皮下组织氧张力在基线时（36 毫米汞柱 vs. 57 毫米汞柱；P = 0.002）和补充供氧后（47 毫米汞柱 vs. 76 毫米汞柱；P = 0.014）显着降低。肥胖患者的上臂皮下组织（43 vs. 54 mmHg；P = 0.011）以及切口附近（42 vs. 62 mmHg；P = 0.012）术后即刻组织氧张力也显着降低。相比之下，术后第一个早晨各组的组织氧张力相当。结论：伤口和组织缺氧在肥胖患者围手术期很常见，并且在手术期间最为明显。即使使用补充氧气组织，肥胖患者的氧张力也会降低到与感染风险大幅增加相关的水平。
Background: Obesity is an important risk factor for surgical site infections. The incidence of surgical wound infections is directly related to tissue perfusion and oxygenation. Fat tissue mass expands without a concomitant increase in blood How per cell, which might result in a relative hypoperfusion with decreased tissue oxygenation. Consequently, the authors tested the hypotheses that perioperative tissue oxygen tension is reduced in obese surgical patients. Furthermore, they compared the effect of supplemental oxygen administration on tissue oxygenation in obese and nonobese patients.Methods: Forty-six patients undergoing major abdominal surgery were assigned to one of two groups according to their body mass index: body mass index less than 30 kg/m(2) (nonobese) or 30 kg/m(2) or greater (obese). Intraoperative oxygen administration was adjusted to arterial oxygen tensions of approximately 150 mmHg and approximately 300 mmHg in random order. Anesthesia technique and perioperative fluid management were standardized. Subcutaneous tissue oxygen tension was measured with a polarographic electrode positioned within a subcutaneous tonometer in the lateral upper arm during surgery, in the recovery room, and on the first postoperative day. Postoperative tissue oxygen was also measured adjacent to the wound. Data were compared with unpaired two-tailed t tests and Wilcoxon rank sum test; P < 0.05 was considered statistically significant.Results: Intraoperative subcutaneous tissue oxygen tension was significantly less in the obese patients at baseline (36 vs. 57 mmHg; P = 0.002) and with supplemental oxygen administration (47 vs. 76 mmHg; P = 0.014). Immediate postoperative tissue oxygen tension was also significantly less in subcutaneous tissue of the upper arm (43 vs. 54 mmHg; P = 0.011) as well as near the incision (42 vs. 62 mmHg; P = 0.012) in obese patients. In contrast, tissue oxygen tension was comparable in each group on the first postoperative morning.Conclusion: Wound and tissue hypoxia were common in obese patients in the perioperative period and most pronounced during surgery. Even with supplemental oxygen tissue, oxygen tension in obese patients was reduced to levels that are associated with a substantial increase in infection risk.