Intraoperative carbon dioxide management and outcomes
Intraoperative carbon dioxide management and outcomes
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DOI：
10.1097/eja.0b013e32833cca07
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发表时间：
2010-09-01
影响因子：
3.6
通讯作者：
Porter, Steven B.
中科院分区：
文献类型：
--
作者：
Wax, David B.;Lin, Hung-Mo;Porter, Steven B.
背景与目的术中过度通气诱导低碳酸血症历来是一种常见的做法，其生理效应可能是有害的。相反，高碳酸血症的影响可能是有益的。由于这些影响可能影响术后恢复，我们调查了选择性结肠切除术和子宫切除术患者术中二氧化碳变化与住院时间之间的关系。方法收集2002 ~ 2008年择期结肠切除术和子宫切除术的电子病历资料。根据手术方式和腹腔镜技术的使用将患者分为四组。提取用于分析的参数包括手术过程中的平均末潮二氧化碳（EtCO2）以及先前被认为影响术后结果的其他参数。住院时间（LOS）由行政记录确定，并用作独立结局变量。对每组进行泊松回归分析，寻找与结果独立相关的因素。结果数据库中3421例病例符合纳入标准。中位EtCO2为31 mmHg。开放和腹腔镜结肠切除术的平均生存期分别为7天和5天，开放和腹腔镜子宫切除术的平均生存期分别为3天和2天。回归分析显示，高EtCO2与结肠切除术和开放式子宫切除术的LOS降低有统计学意义的独立关联。结论术中较高的EtCO2与结肠切除术和开放式子宫切除术后较短的LOS有显著相关性。诱导低碳酸血症的常见做法可能是有害的，维持正常碳酸血症或允许高碳酸血症可改善临床结果。欧洲麻醉学杂志2010；27:819 - 823
Background and objective Intraoperative hyperventilation to induce hypocapnia has historically been common practice and has physiological effects that may be detrimental. In contrast, hypercapnia has effects that may be beneficial. As these effects may influence postoperative recovery, we investigated the association between variations in intraoperative carbon dioxide and length of hospital stay in patients who had elective colon resections and hysterectomies.Methods Data were extracted from electronic records for elective colon resections and hysterectomies done from 2002 to 2008. Patients were divided into four groups based on surgical procedure and use of laparoscopic technique. Parameters extracted for analysis included mean end-tidal carbon dioxide (EtCO2) during the surgical procedure as well as others previously purported to affect postoperative outcomes. Inhospital length of stay (LOS) was determined from administrative records and was used as the independent outcome variable. For each group, Poisson regression analysis was performed to find factors that were independently associated with the outcome.Results A total of 3421 case records in our database met inclusion criteria. Median EtCO2 was 31 mmHg. Median LOS was 7 and 5 days for open and laparoscopic colon resections, and 3 and 2 days for open and laparoscopic hysterectomies, respectively. Regression analysis revealed a statistically significant independent association between higher EtCO2 and reduced LOS for colon resection and open hysterectomy.Conclusion There is a significant association between higher intraoperative EtCO2 and shorter LOS after colon resection and open hysterectomy. The common practice of inducing hypocapnia may be deleterious, and maintaining normocapnia or permitting hypercapnia may improve clinical outcomes. Eur J Anaesthesiol 2010;27:819-823