【罂粟摘要】全身麻醉下行非心脏手术患者吸入氧浓度高低的比较:系统评价和Meta分析

全身麻醉下行非心脏手术患者吸入氧浓度高低的比较:系统评价和Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：吴学艳  编辑：马艳燕  审校：曹莹

背景：对于接受全身麻醉的成人，术中吸入氧浓度(FiO2)的高低，对患者预后的影响存在争议；此项系统回顾和Meta分析研究了高FiO2与低FiO2对患者术后预后的影响。

方法:于2022年3月22日检索了PubMed和Embase两个数据库中的随机临床试验，观察不同FiO2水平对成人全麻下行非心脏手术的影响；两名研究人员独立审查相关研究，提取数据，并评估偏倚风险。对相关结果进行Meta分析，在亚组分析和Meta回归分析中对潜在效应量进行评价，使用GRADE评估证据质量。

结果：本次系统回顾共纳入25项原始研究，分析高(约80%)、低(约30%)FiO2对成年患者在全身麻下行非心脏手术的影响；所有试验的偏倚风险处于中等水平。高FiO2并不能显著降低手术部位感染(OR:0.91,95% CI 0.81至1.02 [p=0.10])；所有其他纳入分析的预后均未发现显著差异，包括死亡率(OR = 1.27, 95% CI:0.90至1.79[p=0.18])和住院时间(平均差异=0.03天，95% CI-0.25至0.30 [p=0.84)。亚组分析和Meta回归分析结果未发现任何明确的影响因素；大多数预后的证据质量评分(GRADE)较低。

Figure 1: Overview of results from meta-analyses of binary outcomes

FiO2: fraction of inspired oxygen, CI: confidence interval

Figure 2: Meta-analysis for short-term mortality

FiO2: Fraction of inspired oxygen, CI: confidence interval

Figure 3: Meta-analysis for surgical site infection

FiO2: Fraction of inspired oxygen, CI: confidence interval

结论：在接受非心脏手术全身麻醉的成人中，高FiO2不能改善患者手术后的预后,包括手术部位感染、住院时长及死亡率；然而，证据质量评分较低。

原始文献来源: Høybye M, Lind PC, Holmberg MJ, et al. Fraction of Inspired Oxygen During General Anesthesia for Non-Cardiac Surgery: Systematic Review and Meta-Analysis. Acta Anaesthesiol Scand[J].2022 Jun 8. DOI: 10.1111/aas.14102. 

英文原文

Long-term oncological outcomes after oral cancer surgery using Fraction of Inspired Oxygen During General Anesthesia for Non-Cardiac Surgery: Systematic Review and Meta-Analysis

Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes.

Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 levels in adults undergoing general anesthesia for non-cardiac surgery. Two investigators independently reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and potential effect measure modification was assessed in subgroup analyses and meta-regression. The evidence certainty was evaluated using GRADE.

Results: This review included 25 original trials investigating the effect of a high (mostly 80%) versus a low (mostly 30%) FiO2 . Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81 to 1.02 [p = 0.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90 to 1.79 [p = 0.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI -0.25 to 0.30 [p = 0.84).Results from subgroup analyses and meta-regression did not identify any clear effect modifiers across outcomes. The certainty of evidence (GRADE) was rated as low for most outcomes.

Conclusions: In adults undergoing general anesthesia for non-cardiac surgery, a high FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.