Increased Long-Term Mortality After a High Perioperative Inspiratory Oxygen Fraction During Abdominal Surgery: Follow-Up of a Randomized Clinical Trial
Increased Long-Term Mortality After a High Perioperative Inspiratory Oxygen Fraction During Abdominal Surgery: Follow-Up of a Randomized Clinical Trial
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DOI：
10.1213/ane.0b013e3182652a51
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发表时间：
2012-10-01
影响因子：
5.7
通讯作者：
Rasmussen, Lars S.
中科院分区：
文献类型：
--
作者：
Meyhoff, Christian S.;Jorgensen, Lars N.;Rasmussen, Lars S.
背景：已推荐围手术期高吸气氧分数（80%）以预防术后伤口感染。然而，最新的和最大的试验之一，PROXI试验，发现手术部位感染没有减少，并且给予80%氧气的患者的30天死亡率更高。在这一后续研究的PROXI试验，我们评估了长期死亡率和围手术期氧分数之间的关联，患者接受腹部surgery.METHODS：从2006年10月8日至2008年10月6日，1386例患者进行了择期或急诊剖腹手术，并随机接受80%或30%的氧气，手术期间和手术后2小时。随访日期为2010年2月24日。生存分析采用Kaplan-Meier统计和考克斯比例风险model.RESULTS：生命状态获得1382 1386例患者后，中位随访2.3年（范围1.3至3.4年）。80%氧气组685例患者中有159例（23.2%）死亡，而30%氧气组701例患者中有128例（18.3%）死亡（HR，1.30 [95%置信区间，1.03 - 1.64]，P = 0.03）。在接受癌症手术的患者中，HR为1.45; 95%置信区间，1.10至1.90; P = 0.009;在非癌症手术后，HR为1.06; 95%置信区间，0.69至1.65; P = 0.79。在围手术期给予80%氧气与显著增加的长-这在接受癌症手术的患者中似乎具有统计学意义，但在非癌症患者中则无统计学意义。（Anesth Analg 2012;115：849-54）
BACKGROUND: A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen. In this follow-up study of the PROXI trial we assessed the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery.METHODS: From October 8, 2006, to October 6, 2008, 1386 patients underwent elective or emergency laparotomy and were randomized to receive either 80% or 30% oxygen during and for 2 hours after surgery. The follow-up date was February 24, 2010. Survival was analyzed using Kaplan-Meier statistics and the Cox proportional hazards model.RESULTS: Vital status was obtained in 1382 of 1386 patients after a median follow-up of 2.3 years (range 1.3 to 3.4 years). One hundred fifty-nine of 685 patients (23.2%) died in the 80% oxygen group compared to 128 of 701 patients (18.3%) assigned to 30% oxygen (HR, 1.30 [95% confidence interval, 1.03 to 1.64], P = 0.03). In patients undergoing cancer surgery, the HR was 1.45; 95% confidence interval, 1.10 to 1.90; P = 0.009; and after noncancer surgery, the HR was 1.06; 95% confidence interval, 0.69 to 1.65; P = 0.79.CONCLUSIONS: Administration of 80% oxygen in the perioperative period was associated with significantly increased long-term mortality and this appeared to be statistically significant in patients undergoing cancer surgery but not in noncancer patients. (Anesth Analg 2012;115:849-54)